1. Association between complications and death within 30 days after noncardiac surgery
- Author
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Spence, J., LeManach, Y., Chan, M.T.V., Wang, C.Y., Sigamani, A., Xavier, D., Pearse, R., Alonso-Coello, P., Garutti, I., Srinathan, S.K., Duceppe, E., Walsh, M., Borges, F.K., Málaga Rodríguez, Germán Javier, Abraham, V., Faruqui, A., Berwanger, O., Biccard, B.M., Villar, J.C., Sessler, D.I., Kurz, A., Chow, C.K., Polanczyk, C.A., Szczeklik, W., Ackland, G., Garg, A.X., Jacka, M., Guyatt, G.H., Sapsford, R.J., Williams, C., Cortes, O.L., Coriat, P., Patel, A., Tiboni, M., Belley-Côté, E.P., Yang, S., Heels-Ansdell, D., McGillion, M., Schünemann, H.J., Parlow, S., Patel, M., Pettit, S., Yusuf, S., Devereaux, P.J., and VISION Investigators
- Subjects
Male ,surgical mortality ,patient monitoring ,Kaplan-Meier Estimate ,mortality rate ,noncardiac surgery ,sepsis ,Postoperative Complications ,Prospective Studies ,Prospective cohort study ,risk reduction ,Mortality rate ,adult ,Hazard ratio ,General Medicine ,Middle Aged ,cohort analysis ,aged ,female ,Surgical Procedures, Operative ,multicenter study (topic) ,Female ,Cohort study ,prospective study ,early diagnosis ,medicine.medical_specialty ,Postoperative Hemorrhage ,surgical technique ,Article ,Sepsis ,male ,Internal medicine ,medicine ,operative blood loss ,Humans ,controlled study ,human ,outcome assessment ,Aged ,Proportional hazards model ,business.industry ,disease association ,heart muscle injury ,Perioperative ,medicine.disease ,major clinical study ,Confidence interval ,purl.org/pe-repo/ocde/ford#3.02.00 [https] ,hospital discharge ,peroperative complication ,hospital admission ,early intervention ,Commentary ,mortality risk ,business - Abstract
BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration:ClinicalTrials.gov, no. NCT00512109.
- Published
- 2019