Common Complications in Cardiothoracic Surgery: Incidence, Risk Factors, Prevention and Management

Cardiothoracic surgery has advanced markedly, yet postoperative complications remain frequent and influential on short‑ and long‑term outcomes. This chapter reviews the incidence, risk factors, prevention and management of major complications across organ systems. Recent registries and meta‑analyses show postoperative atrial fibrillation occurs in 20–40 % of patients, pulmonary complications in up to 40 %, renal injury in 5–30 %, delirium in 25–50 % and stroke in 1–5 %. Patient‑related factors (frailty, renal dysfunction, inflammation, anemia), surgical factors (prolonged cardiopulmonary bypass, urgent surgery, transfusion) and inflammatory or hematologic factors converge to precipitate complications. Evidence‑based prevention and management strategies are discussed for pulmonary complications (atelectasis, pleural effusion, pneumonia, pulmonary edema, embolism), cardiovascular complications (low cardiac output syndrome, perioperative myocardial infarction, arrhythmias, tamponade, graft failure), renal and electrolyte derangements, neurological complications (stroke, delirium, cognitive dysfunction), hematologic disorders (bleeding, coagulopathy, thrombocytopenia, thrombosis), infectious complications and gastrointestinal or hepatic problems. Enhanced recovery after cardiac surgery programs, remote ischemic preconditioning, dexmedetomidine sedation and prophylactic left‑atrial appendage occlusion are highlighted as innovative strategies to reduce morbidity. Quality‑improvement initiatives from the Society of Thoracic Surgeons and the European Association for Cardio‑Thoracic Surgery illustrate how data‑driven benchmarking improves outcomes. Major postoperative complications independently impair long‑term survival, underscoring the need for systematic risk assessment and comprehensive perioperative care. Early ERAS protocols emphasised minimally invasive recovery pathways, and updated guidelines continue to evolve. In summarizing contemporary evidence, this chapter further equips clinicians with practical tools to anticipate, prevent and manage complications, ultimately enhancing survival and recovery in cardiothoracic surgical patients.