Postoperative cardiovascular and renal complications

Postoperative cardiovascular and renal complications represent common and challenging issues in clinical practice, manifesting as a worsening of chronic conditions or new acute processes related to the surgical intervention. These complications often overlap because of the intricate physiological relationship between the heart and kidneys. This chapter explores key postoperative complications: myocardial infarction, arrhythmia (particularly atrial fibrillation), heart failure and acute kidney injury. Myocardial infarction can be difficult to identify, and the definitive invasive investigation and treatment carries its own risks. Postoperative atrial fibrillation can be both a cause of clinical instability, as well as merely being triggered by physiological stressors, and anticoagulation should be considered based on individual risk assessments. Heart failure involves an optimization of cardiac function and fluid balance, where traditional bedside clinical examination is challenging. Acute kidney injury, a multifactorial condition, requires comprehensive diagnostic evaluation and targeted interventions to prevent progression to chronic kidney disease. We underscore the importance of recognizing, evaluating and managing these complications to improve postoperative outcomes for at-risk patients.