Survival after postoperative morbidity: a longitudinal observational cohort study

Abstract

BackgroundPrevious studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity.MethodsWe did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival.ResultsData were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32–3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28–5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62–3.65), returning to baseline thereafter.ConclusionsProlonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications.

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

“…Non-fatal complications occur far more frequently and may affect patients well beyond hospital discharge [16,17]. Reduced quality of life and independence, increased rates of readmission, reduced longer term survival and an increased health economic burden may all follow.…”

Pathophysiology of Major Surgery and the Role of Enhanced Recovery Pathways and the Anesthesiologist to Improve Outcomes

“…[1][2][3][4] A detailed presentation of the biochemical, neuroendocrine, and immunologic changes is beyond the scope of this article.…”

Standardizing endpoints in perioperative research

“…Perioperative morbidity has additional implications for the use of healthcare resources and is increasingly recognized as a predictor of long-term outcome. 21,22 Recent characterization of the high-risk surgical population has also steered attention towards perioperative morbidity. 23 Although this population comprises only 10-15% of all surgical patients, it accounts for over 80% of postoperative complications and resource costs.…”