Association between complications and death within 30 days after noncardiac surgery

Spence, Jessica; LeManach, Yannick; Chan, Matthew T., V; Wang, C. Y.; Sigamani, Alben; Xavier, Denis; Pearse, Rupert; Alonso-Coello, Pablo; Garutti, Ignacio; Srinathan, Sadeesh K.; Duceppe, Emmanuelle; Walsh, Michael; Borges, Flavia Kessler; Malaga, German; Abraham, Valsa; et. al.

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: , no. NCT00512109.

Más información

Título según WOS: ID WOS:000477729300002 Not found in local WOS DB
Título de la Revista: CANADIAN MEDICAL ASSOCIATION JOURNAL
Volumen: 191
Número: 30
Editorial: CMA-CANADIAN MEDICAL ASSOC
Fecha de publicación: 2019
Página de inicio: E830
Página final: E837
DOI:

10.1503/cmaj.190221

Notas: ISI