What is the clinical evidence from this study?

Study design: Cohort. Population: Surgical patients (n=28350953). Intervention: Perioperative organ injury vs. No perioperative organ injury. Primary outcome: In-hospital mortality (OR 9.28, 95% CI 9.22-9.35, p=<0.001).

April 9, 2025Nature Communications15 citationsOpen Access

Impact of perioperative organ injury on morbidity and mortality in 28 million surgical patients

Q: What are the key findings of this study?

Perioperative organ injury was associated with a 9-fold higher odds of in-hospital death and prolonged hospital stay by 11.2 days compared to patients without such a diagnosis.

Q: What does this research mean for the field?

Perioperative organ injury is associated with a 9-fold higher odds of in-hospital death and prolonged hospital stay by 11.2 days compared to patients without such a diagnosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

FKFelix KorkUniversitätsklinikum Aachen YLYafen LiangPain and Rehabilitation Medicine AGAdit A. GindeAnna Needs Neuroblastoma Answers

Key Result

Perioperative organ injury was associated with a 9-fold higher odds of in-hospital death and prolonged hospital stay by 11.2 days compared to patients without such a diagnosis.

Study Design

Type

Cohort (n=28,350,953)

Multicenter

Yes

Structured PICO

Does perioperative organ injury increase in-hospital mortality and length of stay in surgical patients?

Population

28,350,953 cases of elective and emergent surgeries in Germany over 4 years

Intervention

Perioperative organ injury (exposure)

Comparator

No perioperative organ injury

Outcome

In-hospital mortality and hospital length of stayhard clinical

Perioperative organ injury affects 4.4% of surgical patients and is associated with a 9-fold increase in mortality and an 11.2-day increase in hospital stay.

Main Result

Effect estimate: OR 9.28 (95% CI 9.22-9.35)

Absolute Event Rate: 17% vs 0.7%

p-value: p=<0.001

Limitations

Data derived from a single European country, which may not represent global healthcare systems
Organ injury coding may contain inaccuracies and be influenced by external coding incentives
Lack of granularity to identify subclinical organ injury
Only included hospitalized surgical patients, excluding out-patient surgical populations
In-hospital mortality is an incomplete measure of surgical mortality as it misses deaths after discharge

Abstract

Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated with the lowest mortality (10.8%). This was followed by acute myocardial infarction (incidence 0.6%, mortality 15.6%), stroke (incidence 0.6%, mortality 13.1%), pulmonary embolism (incidence 0.3%, mortality 20.0%), liver injury (incidence 0.1%, mortality 68.7%), and acute respiratory distress syndrome (incidence 0.1%, mortality 44.7%). These findings help prioritize interventions for preventing or treating individual types of perioperative organ injury.

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