There have been few large-scale, prospective cohort studies focusing on postoperative cardiovascular complications and their impact on postoperative mortality. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30-day all-cause mortality. The authors performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The results are of clinical relevance to all who care for patients in the peri-operative period.