Perioperative cardiac arrest requiring admission to intensive care units in Japan: epidemiological differences between emergency and elective surgery.

Background: Perioperative cardiac arrest is more prevalent in emergency surgery and carries substantial mortality risks; however, large-scale studies examining its incidence, aetiology, and outcomes remain scarce. This study investigated the epidemiology of perioperative cardiac arrest in emergency and elective surgeries in Japan.

Methods: We conducted a multicentre retrospective cohort study using the Japanese Intensive care PAtient Database (JIPAD), a nationwide ICU registry. Patients coming from the operating theatre who experienced cardiac arrest before ICU admission between April 2015 and March 2023 were included. Patients were categorised as undergoing emergency or elective surgery, and group comparisons were performed for the incidence, surgical procedures, aetiologies, and clinical outcomes.

Results: Perioperative cardiac arrest occurred in 874/214 303 (0.41%) surgical ICU admissions, including 563/32 408 (1.74%) of emergency surgeries and 311/181 895 (0.17%) of elective surgeries. In emergency surgeries, the most frequent surgical procedure was acute aortic dissection repair (n=90, 16.0%), whereas the most common procedure in elective surgeries was gastrointestinal neoplasm resection (n=39, 12.5%). Acute aortic syndrome was the leading aetiology in emergency surgery (n=176, 31.3%), whereas valvular heart disease (n=48, 15.4%) and acute coronary syndrome (n=42, 13.5%) were the leading aetiologies in elective surgery. Both in-hospital mortality (46.2% vs 15.8%) and transfers to other healthcare facilities (28.8% vs 14.8%) were significantly higher in emergency surgeries.

Conclusions: This nationwide study reveals significant differences in the incidence, surgical procedures, aetiologies, and clinical outcomes of perioperative cardiac arrest between emergency and elective surgery.