Study Indicate Need for Improved Risk Assessment Tools in Cardiac Surgery Patients

How common are life-threatening complications within the first day after cardiac surgery, especially in resource-limited settings? This question is critical for clinicians managing complex cardiac surgical patients in low- and middle-income countries (LMICs), where postoperative monitoring can be challenging and outcome data are scarce.

Study Design and Patient Population

This retrospective, single-center cohort study analyzed 108 adult patients who underwent cardiac surgery with cardiopulmonary bypass at a national referral hospital in El Salvador between 2017 and 2021. The team collected demographic, clinical, and surgical data, focusing on the incidence and type of complications within the first 24 hours post-surgery. Preoperative risk was assessed using both the CARE score (which includes anesthesia-related factors) and the commonly-used EuroSCORE II system.

Key Findings: High Incidence of Early Complications

Nearly 44% of patients (47 out of 108) experienced at least one complication in the first 24 hours.

Cardiovascular complications were most common, affecting 39% of patients. These included low cardiac output, hypotension, and dangerous arrhythmias.

Renal complications, defined as acute kidney injury requiring dialysis, occurred in 10% of patients.

Infections (8%) and respiratory issues (7%) were also notable, though neurological complications were not seen within the first day.

New atrial fibrillation developed in about 10% of patients.

Risk Assessment: CARE and EuroSCORE II

The study evaluated the ability of the CARE score to predict early morbidity, finding limited to moderate discrimination (AUC 0.67). This means that while the CARE score offered some predictive value, it was not highly accurate for identifying patients at risk for complications in this LMIC setting. EuroSCORE II was reported for descriptive purposes but could not be fully validated due to missing in-hospital mortality data.

Why It Matters: Context for Clinicians

These results highlight the substantial burden of early postoperative morbidity in LMICs, where structural and resource limitations may influence outcomes. The predominance of cardiovascular complications aligns with the known impact of cardiopulmonary bypass and the inflammatory cascade it triggers. The study also underscores the importance of local data for adapting risk models and perioperative strategies, as tools developed in high-income countries may not perform optimally in different populations.

Limitations and Clinical Implications

The study’s retrospective and single-center design limits broad applicability, and the absence of long-term follow-up or mortality data is a drawback. Still, these findings call attention to the need for improved monitoring, risk stratification, and context-specific perioperative care—especially in resource-limited environments.

Conclusion

Early postoperative complications after cardiac surgery are frequent in this LMIC cohort, mostly affecting the cardiovascular system. Existing risk models like CARE show only moderate value for prediction, emphasizing the need to develop and validate local strategies for better patient outcomes.

Key points

Early complications occurred in 44% of cardiac surgery patients; cardiovascular events were most frequent.

CARE score showed only moderate accuracy in predicting early postoperative complications.

Renal, infectious, and respiratory complications were also common in the first 24 hours.

No neurological complications were seen within the first day post-surgery.

Local outcome data are critical to guide risk assessment and improve perioperative care in LMICs.

Citation:

Velásquez JMR, Deras B. Early postoperative complications and risk assessment in cardiac surgery: A cohort study. Ann Card Anaesth 2026;29:367-71. DOI: 10.4103/aca.aca_351_25