What is APECx?
APECx is an adaptive, international, multicentre observational study designed to map real-world anaesthesia, perfusion, and surgical practices in adult cardiac surgery.
By collecting high-quality global data, APECx aims to better understand variation in perioperative care and identify opportunities to improve patient outcomes.
The study is investigator-initiated and led by Amsterdam UMC, in collaboration with clinicians and researchers worldwide.
Why this matters
Cardiac surgery outcomes vary widely across centres and regions, not only due to patient factors but also differences in perioperative management.
Despite advances in surgical techniques, there is still limited high-quality evidence guiding anaesthesia, perfusion, and intraoperative strategies.
This variation directly impacts complications such as acute kidney injury, pulmonary complications, ICU stay, and mortality.
APECx addresses this gap by systematically studying global practice variation and identifying modifiable factors that can improve outcomes.
What we do
- Collect real-world perioperative data in cardiac surgery patients worldwide
- Analyse global variation in anaesthesia, perfusion, and surgical practices
- Identify modifiable factors associated with clinical outcomes
- Study differences across regions, healthcare systems, and patient populations
- Generate evidence to inform future guidelines and clinical trials
Scientific foundation
APECx is an adaptive, prospective cohort study conducted across cardiac surgery centres worldwide. Study duration: ~10 years with multiple evolving phases.
Each phase focuses on a specific research question (e.g. ventilation strategies). Data collection occurs twice per year in short, structured inclusion periods. All data are derived from routine clinical care. Minimal burden, no added risk.
The adaptive design allows continuous learning, enabling the study to evolve as new questions and evidence gaps emerge.
Impact
For individuals
Improving patient outcomes by identifying safer perioperative strategies and reducing complications.
For researchers
Providing a global dataset to understand practice variation and generate high-impact research.
For healthcare
Supporting more consistent, evidence-based care across institutions and regions.
For society
Driving standardisation and equity in cardiac surgery outcomes worldwide.
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