Older age, higher BMI, preoperative hyperthyroidism, higher preoperative ALT and BNP levels, and longer surgical duration are associated with an increased risk of postoperative MACE in elderly patients undergoing major thoracic and abdominal surgery, while intraoperative regional blockade may have a protective effect against postoperative MACE.
Key Findings
Results
The incidence of perioperative major adverse cardiovascular events (MACE) was 4.6% among elderly patients undergoing major thoracic and abdominal surgery.
88 out of 1,915 patients experienced perioperative MACE (88/1,915 = 4.6%)
Study population included 1,252 males and 663 females with a mean age of 72±5 years
All patients were aged ≥65 years undergoing elective non-cardiac major thoracic and abdominal surgery (≥2 hours) under general anesthesia
Data were collected retrospectively from Peking University First Hospital from November 1, 2021 to July 31, 2023
Results
Older age was identified as an independent risk factor for postoperative MACE in elderly surgical patients.
OR=1.051, 95% CI: 1.007–1.097, P=0.023
Each additional year of age increased the odds of MACE by approximately 5.1%
Identified via multivariate logistic regression analysis
Results
Higher body mass index (BMI) was independently associated with increased risk of postoperative MACE.
OR=1.111, 95% CI: 1.033–1.195, P=0.005
Each unit increase in BMI was associated with an approximately 11.1% increase in odds of MACE
Identified via multivariate logistic regression analysis
Results
Preoperative coronary heart disease was an independent risk factor for postoperative MACE.
OR=1.934, 95% CI: 1.107–3.381, P=0.021
Patients with preoperative coronary heart disease had approximately 93% higher odds of developing postoperative MACE compared to those without
Identified via multivariate logistic regression analysis
Results
Preoperative hyperthyroidism was the strongest risk factor identified for postoperative MACE.
OR=28.691, 95% CI: 3.207–256.640, P=0.003
Patients with preoperative hyperthyroidism had approximately 28.7 times the odds of developing postoperative MACE compared to those without
The wide confidence interval reflects the likely small number of patients with hyperthyroidism in the cohort
Identified via multivariate logistic regression analysis
Results
Higher preoperative alanine transaminase (ALT) level was independently associated with increased risk of postoperative MACE.
OR=1.007, 95% CI: 1.001–1.014, P=0.021
Each unit increase in preoperative ALT was associated with a 0.7% increase in the odds of postoperative MACE
Identified via multivariate logistic regression analysis
Results
Higher preoperative B-type natriuretic peptide (BNP) level was independently associated with increased risk of postoperative MACE.
OR=1.003, 95% CI: 1.002–1.004, P<0.001
This was among the most statistically significant findings (P<0.001)
Each unit increase in preoperative BNP was associated with a 0.3% increase in odds of postoperative MACE
Identified via multivariate logistic regression analysis
Results
Longer surgical duration was independently associated with increased risk of postoperative MACE.
OR=1.003, 95% CI: 1.001–1.005, P=0.011
All surgeries included were ≥2 hours in duration
Identified via multivariate logistic regression analysis
Results
Intraoperative regional blockade was identified as a protective factor against postoperative MACE.
OR=0.310, 95% CI: 0.189–0.508, P<0.001
Use of regional blockade was associated with approximately 69% lower odds of postoperative MACE compared to non-use
This was among the most statistically significant findings (P<0.001)
Identified via multivariate logistic regression analysis
What This Means
This research suggests that among older patients (age 65 and above) having major chest or abdominal surgery, about 1 in 22 (4.6%) experienced a serious heart-related complication called a major adverse cardiovascular event (MACE) — which can include heart attacks, dangerous heart rhythms, or other cardiac crises. The study examined records from nearly 2,000 patients at a large Chinese hospital to understand which patient characteristics and surgical factors were linked to these complications. Several factors were found to increase risk: being older, having a higher body weight (BMI), having pre-existing coronary heart disease or an overactive thyroid (hyperthyroidism), having elevated liver enzyme (ALT) or heart-stress hormone (BNP) levels before surgery, and undergoing longer operations. Notably, hyperthyroidism carried an especially large associated risk increase.
On the protective side, the use of regional nerve blocks during surgery — a technique where local anesthetic is used to numb a specific area of the body — was associated with roughly 69% lower odds of experiencing a cardiovascular complication. This finding highlights a potentially modifiable factor that anesthesia teams may consider when planning care for high-risk elderly surgical patients.
This research suggests that careful preoperative screening for cardiac and metabolic conditions such as hyperthyroidism, coronary disease, and elevated BNP, combined with consideration of regional anesthetic techniques, may be important in reducing serious heart complications in older patients undergoing major surgery. The findings support efforts to identify and optimize high-risk patients before elective operations.
Li Y, Ma J, Zhang Z, Wang T. (2026). [Influencing factors for major cardiovascular adverse events in elderly patients following major thoracic and abdominal surgery].. Zhonghua yi xue za zhi. https://doi.org/10.3760/cma.j.cn112137-20260107-00071