November 2022 CASCADE Update

CASCADE (CArdiovaSCulAr outcomes after major abDominal surgEry) was an international, prospective multi-centre audit designed and led by STARSurg and EuroSurg in the United Kingdom and Europe from January to July 2022. We set out to characterise the incidence of postoperative cardiac complications (PCCs) following major abdominal surgery based on definitions published by the STEP COMPAC Initiative in 2021. The lack of consensus in definitions previously led to significant variability between studies in their reported PCC rates.

Based on European perioperative guidelines, we aimed to audit compliance to pre-, intra-, and postoperative standards aimed at reducing the risk of PCCs. Our secondary aims included (1) characterising the incidence of PCCs, (2) identifying risk factors for PCCs, and (3) exploring the association of PCCs with postoperative morbidity and mortality. 

CASCADE exceeded our expectations, with 24,260 patients included in the final dataset. It is the largest study STARSurg or EuroSurg have conducted to date.

These are the early results of our analysis:

• The adjusted PCC rate across the CASCADE cohort was 2.38%.
• The highest incidence of PCCs was in the first 10 days following the surgery.
• Only 3.9% of patients with iron deficiency anaemia received iron supplementation perioperatively, and only 81.5% of surgeries followed the WHO Surgical Safety Checklist.

There is ongoing analysis of the CASCADE dataset to explore:

• Risk factors for PCCs.
• Association between PCCs and mortality.
• Venous thromboembolic event incidence and prophylaxis.