Key Points Question Do rates of opioid prescriptions dispensed after surgical procedures differ among countries? Findings In this cohort study, more than 70% of surgical patients in the United States and Canada filled opioid prescriptions after 4 surgical procedures compared with only 11% in Sweden. Of the 3 countries examined, the United States had the highest average dose of opioid prescriptions for most surgical procedures. Meaning There is very large variability in the use of opioids after surgery in different countries, suggesting the potential to reevaluate prescribing practices.

Background Surgical audit, sometimes including public reporting, is an important foundation of high quality health care. We aimed to assess the validity of a novel outcome metric, days at home up to 30 days after surgery , as a surgical outcome measure in clinical trials and quality assurance. Methods This was a multicentre, registry-based cohort study. We used prospectively collected hospital and national healthcare registry data obtained from patients aged 18 years or older undergoing a broad range of surgeries in Sweden over a 10-year period. The association between days at home up to 30 days after surgery and patient (older age, poorer physical status, comorbidity) and surgical (elective or non-elective, complexity, duration) risk factors, process of care outcomes (re-admissions, discharge destination), clinical outcomes (major complications, 30-day mortality) and death up to 1 year after surgery were measured. Findings From January, 2005, to December, 2014, we obtained demographic and perioperative data on 636,885 patients from 21 Swedish hospitals. Mortality at 30 days and one year was 1.8% and 7.3%, respectively. The median (IQR) days at home up to 30 days after surgery was 27 (23–29), being significantly lower among high-risk patients, those recovering from more complex surgical procedures, and suffering serious postoperative complications (all p < 0.0001). Patients with 8 days or less at home up to 30 days after surgery had a nearly 7-fold higher risk of death up to 1 year postoperatively when compared with those with 29 or 30 days at home (adjusted HR 6.78 [95% CI: 6.44–7.13]). Interpretation Days at home up to 30 days after surgery is a valid, easy to measure patient-centred outcome metric. It is highly sensitive to changes in surgical risk and impact of complications, and has prognostic importance; it is therefore a valuable endpoint for perioperative clinical trials and quality assurance. Funding Swedish National Research Council Medicine and Stockholm County Council ALF-project grant (LE), and the Australian National Health and Medical Research Council (PM).

In a cohort of 300 patients undergoing major elective noncardiac surgery, there was a high incidence of myocardial damage and an association between an intraoperative reduction in SBP more than 50% from baseline lasting more than 5 min and myocardial damage.