Factors Associated with Intraoperative Arrhythmias in Adult Surgical Patients: A Prospective Observational Study

Intraoperative arrhythmias are a major concern in patients undergoing surgery under general anesthesia, contributing to increased morbidity, prolonged ICU stays, and extended hospitalization. Despite their impact, evidence on their prevalence and determinants remains limited in low-resource settings such as Ethiopia. This study was conducted at Tikur Anbessa Specialized Hospital (TASH), the largest tertiary referral and teaching hospital in Ethiopia, serving a diverse population from across the country. This study aimed to determine the prevalence of intraoperative arrhythmias and identify associated factors among surgical patients at Tikur Anbessa Specialized Hospital.

A prospective, institution-based cross-sectional study was conducted among adult surgical patients. A systematic sampling technique was used to select 312 participants, enrolling every fourth patient from the sampling frame. The primary outcome was intraoperative arrhythmia, while exposures included sociodemographic characteristics, clinical conditions, anesthesia-related factors, and intraoperative variables such as blood loss and transfusion. Data was analyzed using SPSS version 27. Associations between independent variables and intraoperative arrhythmias were assessed using binary logistic regression. Variables with p < 0.20 in bivariate analysis were included to avoid excluding potential predictors. Variables with a p-value < 0.05 in the multivariable analysis were considered statistically significant, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Of 312 patients assessed, 9 were excluded for missing data on the primary outcome; thus, 303 were included in the final analysis. Of these, 126 (42%) developed intraoperative arrhythmias. Multivariate logistic regression identified that patients with ASA class III had higher odds of developing intraoperative arrhythmia compared to ASA I (AOR = 2.90, 95% CI: 1.69–5.22). General anesthesia was also associated with an increased risk of intraoperative arrhythmia compared to spinal anesthesia (AOR = 2.4, 95% CI: 1.29–4.43). Additionally, patients who received intraoperative blood transfusions were more likely to experience arrhythmias compared to those who did not receive transfusion (AOR = 1.7, 95% CI: 1.22–2.21).

The prevalence of intraoperative arrhythmias was high, particularly among patients with ASA class III status, those receiving general anesthesia, and those requiring intraoperative blood transfusion. Strengthening preoperative risk assessment, ensuring vigilant intraoperative monitoring, and providing prompt management of arrhythmic events are crucial for improving perioperative outcomes in high-risk surgical populations.