To investigate the incidence and related influencing factors of postoperative acute heart failure in patients with gynecological malignant tumors, in order to prevent and reduce the occurrence of postoperative acute heart failure (AHF), thereby improving the therapeutic effect and prognosis of these patients.

A retrospective analysis was performed on the clinical data of gynecological malignant tumor patients who were hospitalized and underwent surgery at the Second Hospital of Hebei Medical University from January 2021 to December 2023, including age, body mass index (BMI), medical history, and auxiliary examination results after admission: white blood cell count (WBC), hemoglobin (HGB), platelet count (PLT), D-dimer, alanine aminotransferase (ALT), total bilirubin (TBil), creatinine (Cr), left ventricular ejection fraction (LVEF), surgical duration, intraoperative blood loss, postoperative day 1 fluid replacement volume, and postoperative day 1 urine volume. According to whether AHF occurred from postoperative to discharge, the patients were divided into an AHF group and a non-AHF group, and the differences in the above indicators between the two groups were compared.

Among the 1049 patients included, 100 had postoperative AHF, with an incidence rate of 9.53%. Specifically, the incidence rate of postoperative AHF was 8.67% for cervical cancer patients, 11.71% for ovarian cancer patients, 9.04% for endometrial cancer patients, and 11.1% for other gynecological malignant tumors. There were significant differences between the AHF group and the non-AHF group in BMI, hypertension, diabetes, D-dimer, LVEF, operation duration, intraoperative blood loss, and fluid replacement volume on the first day after operation (P<0.05). The duration of surgery and the amount of fluid replenished on the first day after surgery were identified to be independent risk factors for AHF after gynecological malignant tumor surgery (P<0.05). With respective cutoff values of 4.25 and 2275, the area under the ROC curve values of the duration of surgery and the amount of fluid replacement on the first day after surgery for predicting AHF were 0.657 and 0.730, respectively, with cutoff values of 4.25 and 2275.

AHF is a common postoperative complication in patients with gynecological malignancies. Patients with gynecological malignancies with a high BMI, diabetes, hypertension, high D-dimer, low LVEF, long operation time, excessive intraoperative blood loss, and excessive fluid replacement on the first day after operation tend to develop postoperative AHF. Accurate preoperative evaluation, paying attention to the management of patients with a high BMI, hypertension, diabetes, high D-dimer, and low LVEF, shortening the length of surgery, reducing intraoperative bleeding, and adjusting the amount of postoperative fluid replacement can reduce the risk of AHF, thus improving the therapeutic effect and prognosis of such patients.