Association between complications and death within 30 days after noncardiac surgery
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Why the study?
Little is known about the frequency and timing of death and the associations between perioperative complications and mortality among adults undergoing contemporary noncardiac surgery.
Population
40 004 patients aged 45 years and older undergoing inpatient noncardiac surgery
Comparison
Perioperative complications vs no complications
Design
Multicenter prospective cohort study across 28 centres in 14 countries
Follow-up
30 days
Authors
Discussion
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Implication
Targeting major bleeding, MINS, and sepsis may reduce postoperative mortality; hypothesis-generating for prevention trials.
Key Points
- To determine the frequency, timing, and association of perioperative complications with 30-day mortality in patients undergoing inpatient noncardiac surgery.
- Interventional multicenter trial involving 40,004 patients aged 45 years and older undergoing inpatient noncardiac surgery across 28 centres in 14 countries (ClinicalTrials.gov, NCT00512109).
- Monitored patients for perioperative complications up to 30 days post-surgery and evaluated their relationship with 30-day mortality using a Cox proportional hazards model.
- Of 40,004 patients, 715 (1.8%) died within 30 days: 5 deaths (0.7%) occurred in the operating room, 500 (69.9%) during index hospital admission, and 210 (29.4%) after hospital discharge.
- Eight complications independently predicted mortality, with 44.9% of all deaths attributable to major bleeding (adjusted HR 2.6, 95% CI 2.2–3.1; AF 17.0%), myocardial injury after noncardiac surgery (adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%), and sepsis (adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%).
Structured PICO
P
Population
40,004 patients aged 45 years and older who underwent inpatient noncardiac surgery, received general or regional anesthesia, and remained in hospital for at least 1 night, mean age 63.9, 50% female, multinational (28 centres in 14 countries).
O
Outcome
30-day mortality and its association with perioperative complicationshard clinical
Among adults undergoing noncardiac surgery, 99.3% of deaths occurred postoperatively, with major bleeding, myocardial injury (MINS), and sepsis accounting for nearly 45% of 30-day mortality.
Limitations
- Did not adjudicate some outcomes (major bleeding, sepsis, infection without sepsis, congestive heart failure and acute kidney injury with dialysis)
- Data from Africa were based on a single centre
Cite This Study
Spence et al. (2019) studied this question.
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