What is the clinical evidence from this study?

Study design: Cohort. Population: Elective surgery (n=49913). Intervention: Postoperative complications vs. No postoperative complications. Primary outcome: Change in healthcare contact days in the 2 years before and after surgery (IRR 1.67, 95% CI 1.49-1.87).

What question did this study set out to answer?

To assess how sentinel postoperative complications affect long-term healthcare contact days and two-year mortality following elective surgery.

June 16, 2023BJA OpenOpen Access

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

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Key result

Postoperative complications linked to a ~67% increase in healthcare contact days two years post-surgery.

IRR 1.67
95% CI 1.49-1.87
n=49,913

Why the study?

Postoperative complications are linked to reduced long-term survival, but healthcare use changes after sentinel postoperative complications have not been well characterised.

Do postoperative complications increase long-term healthcare use and mortality in patients undergoing elective surgery?

Key Points

To assess how sentinel postoperative complications affect long-term healthcare contact days and two-year mortality following elective surgery.
Linked routine primary and secondary care electronic records for 49,913 elective surgery patients (median age 49 years; 56.0% female) across four East London hospitals (2012–2017) with at least 90 days follow-up.
Identified sentinel complications within 90 days of surgery, including wound infection, urinary tract infection, pneumonia, acute stroke, and myocardial infarction.
Quantified healthcare contact days in the two years before and after surgery using negative binomial regression adjusted for baseline healthcare use and clinical confounders.
Complications occurred in 3,883 patients (7.8%), whose healthcare contact days increased from 18.4 to 25.3 days/year post-surgery (rate ratio [RaR] 1.38, 95% CI 1.37–1.39), compared to an increase from 12.3 to 14.0 days/year in patients without complications (RaR 1.14, 95% CI 1.14–1.15).
The adjusted incidence rate ratio of healthcare contact days associated with postoperative complications was 1.67 (95% CI 1.49–1.87).
Two-year mortality was over three times higher in patients who experienced complications (391/3,883 [10.1%]) compared with those who did not (1,428/46,030 [3.1%]).

Study Design

Type

Cohort (n=49,913)

Multicenter

Yes

Structured PICO

Do postoperative complications increase long-term healthcare use and mortality in patients undergoing elective surgery?

Population

49,913 patients undergoing elective surgery at four East London hospitals (2012-2017) with at least 90 days follow-up, median age 49, 56.0% female.

Intervention

Postoperative complications (wound infection, urinary tract infection, pneumonia, new stroke, and new myocardial infarction) within 90 days of surgery

Comparator

No postoperative complications within 90 days of surgery

Outcome

Change in healthcare contact days in the 2 years before and after surgery

Main Result

Effect estimate: IRR 1.67 (95% CI 1.49-1.87)

Absolute Event Rate: 25.3% vs 14%

Postoperative complications are associated with a significant increase in long-term healthcare utilization and 2-year mortality.

Authors

AFAlexander J. FowlerCochlear (Australia)ABAdam BrayneWellcome Centre for Cell-Matrix Research RPRupert M. PearseUniversity College Dublin

Discussion

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Implication

Postoperative complications may increase long-term healthcare utilization after elective surgery; leaves open causal effects on contact days and mortality.

Cite This Study

Fowler et al. (2023) conducted a cohort in Elective surgery (n=49,913). Postoperative complications vs. No postoperative complications was evaluated on Change in healthcare contact days in the 2 years before and after surgery (IRR 1.67, 95% CI 1.49-1.87). Postoperative complications were associated with a greater increase in healthcare contact days in the 2 years after surgery compared to no complications (adjusted IRR 1.67; 95% CI 1.49-1.87).

synapsesocial.com/papers/6a090852bee8d5ab8a92db09 https://doi.org/10.1016/j.bjao.2023.100142

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Implication

Postoperative complications may increase long-term healthcare utilization after elective surgery; leaves open causal effects on contact days and mortality.

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

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Also Consider