Long-term healthcare use after postoperative complications: a prospective analysis of linked primary and secondary care routine data

Complications and consequences: short-term harm has long-term impact

“…Complications after surgery are distressing and unpleasant for patients, a burden on health system resources, and have substantive long-term health implications. The study by Fowler and colleagues 1 published in the September 2023 issue of BJA Open adds to the literature supporting the notion that complications are key determinants of long-term outcomes and health system burden after surgery.…”

“…In Europe, Vonlanthen and colleagues 3 showed an increase of up to five times in inpatient care cost in patients who experienced complications. The study by Fowler and colleagues 1 suggests that this increased healthcare use extends beyond the index admission. Although all patients saw an increase in healthcare use after surgery, this rate was significantly higher in those who experienced the selected complications.…”

“…In addition, Fowler and colleagues 1 identified a more than three-fold increase in the incidence of death within 2 yr of major surgery in patients who experienced a complication compared with patients who experienced an uncomplicated recovery. This observation is clearly limited by confounding in that patients identified as having a higher preoperative risk of adverse outcomes are more likely to experience both complications and death; a common causal relationship is present.…”

“…Rather, clinicians must seek to understand the long-term implications of surgery and its possible complications for both patients and healthcare systems. The work by Fowler and colleagues 1 builds on the existing literature, suggesting that even in survivors, there is ongoing increased healthcare use, which may be linked to reduced quality of life and patient experience and higher costs and resource utilisation.…”

“…Future research should build on the work of Fowler and colleagues 1 to develop a more complete understanding of postoperative recovery. This is a complex and dynamic process, which may not be best evaluated by point estimates.…”