Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival

Abstract

Background: Major surgery is associated with high rates of postoperative complications, many of which are deemed preventable. It has been suggested that these complications not only present a risk to patients in the short term, but may also reduce long-term survival. The aim of this review was to examine the effects of postoperative complications on long-term survival. Methods: MEDLINE, Web of Science and reference lists of relevant articles were searched up to July 2013. Studies assessing only procedure-specific, or technical failure-related, complications were excluded, as were studies of poor methodological quality. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using funnel plots. Results: Eighteen eligible studies were included, comprising results for 134 785 patients with an overall complication rate of 22⋅6 (range 10⋅6-69) per cent. The studies included operations for both benign and malignant disease. Median follow-up was 43 (range 28-96) months. Meta-analysis demonstrated reduced overall survival after any postoperative complication for ten studies with eligible data (20 755 patients), with a hazard ratio (HR) of 1⋅28 (95 per cent confidence interval 1⋅21 to 1⋅34). Similar results were found for overall survival following infectious complications: HR 1⋅92 (1⋅50 to 2⋅35). In analyses of disease-free survival the HR was 1⋅26 (1⋅10 to 1⋅42) for all postoperative complications and 1⋅55 (1⋅12 to 1⋅99) for infectious complications. Inclusion of poor-quality studies in a sensitivity analysis had no effect on the results.Conclusion: Postoperative complications have a negative effect on long-term survival. This relationship appears to be stronger for infectious complications.

Effectiveness of interventions to improve patient handover in surgery: A systematic review

“…Previous studies have suggested that a score of 7 or greater represents studies of acceptable quality. 19,20 We evaluated randomized trials by using the Jadad score, 21 assigning a quality score from 1 to 5 (a score of 3 or greater being considered acceptable), with points assigned depending on the appropriateness of randomization, blinding, and description of any dropouts or exclusions.…”

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

“…Various reports have shown that such postoperative complications frequently reduce the overall survival (OS) as well as cancer‐specific survival after major surgery for cancer 9. In particular, severe postoperative complications are associated with impaired long‐term survival after gastroesophageal and pancreatic cancer surgery 10.…”

“…For the improvement of long‐term survival, it is essential to minimize mortality by optimizing surgical techniques and perioperative care 17, 18, 19. In addition, severe infections, pulmonary complications, and liver dysfunction require extended intensive care and long hospital stays for some patients 9, 20. A history of such postoperative complications increases the likelihood of poor survival.…”

Re: Postoperative Complications do not Affect Long‐term Outcome in Esophageal Cancer Patients

“…Though not yet fully elucidated, molecular and immune mechanisms underlying this relationship are being actively investigated; pathways including neutrophil-cancer cell interactions [7,8] and bacterial antigen receptor cell activation [9,10] have been previously implicated. A recent meta-analysis of long-term survival following complications after surgery published by our group [11], incorporating results for over 20,000 patients, has reported similar conclusions, with a significant reduction in long-term survival for patients with postoperative complications (hazard ratio and 95 % confidence interval: 1 Considering this discrepancy, we note that in Lindner and colleagues' examined cohort, adenocarcinoma patients who suffered major complications had a reduced survival (median 29.9 months) compared to those with no complications (33.2 months), with a similar trend for patients who suffered anastomotic leak (33.7 months) compared to those who did not (42.8 months). Though this did not reach statistical significance, this trend would appear to potentially contradict the authors' conclusions.…”