Key result
Postoperative complications were associated with a dose-response increase in long-term mortality across all settings (e.g., HR 1.30, 95% CI 1.23-1.38 for one complication in outpatient surgery).
Why the study?
Postoperative complications drive costs and increase perioperative mortality, but the extent to which they are associated with long-term survival remains unclear.
Does the occurrence of postoperative complications increase the risk of long-term mortality in Veterans undergoing non-cardiac surgery?
Cohort (n=699,002)
Yes
Does the occurrence of postoperative complications increase the risk of long-term mortality in Veterans undergoing non-cardiac surgery?
Hazard Ratio: 1.3 (95% CI 1.23–1.38)
Postoperative complications after non-cardiac surgery are associated with a dose-dependent increase in long-term mortality beyond the immediate postoperative period.
Postoperative complications signal elevated long-term mortality risk; leaves open whether prevention alters survival in non-cardiac surgery.
OBJECTIVE: To evaluate the relationship between postoperative complications and long-term survival. SUMMARY AND BACKGROUND: Postoperative complications remain a significant driver of healthcare costs and are associated with increased perioperative mortality, yet the extent to which they are associated with long-term survival is unclear. METHODS: National cohort study of Veterans who underwent non-cardiac surgery using data from the Veterans Affairs Surgical Quality Improvement Program (2011-2016). Patients were classified as having undergone outpatient, low-risk inpatient, or high-risk inpatient surgery. Patients were categorized based on number and type of complications. The association between the number of complications (or the specific type of complication) and risk of death was evaluated using multivariable Cox regression with robust standard errors using a 90-day survival landmark. RESULTS: Among 699,002 patients, complication rates were 3.0%, 6.1%, and 18.3% for outpatient, low-risk inpatient, and high-risk inpatient surgery, respectively. There was a dose-response relationship between an increasing number of complications and overall risk of death in all operative settings [outpatient surgery: no complications (ref); one-hazard ratio (HR) 1.30 (1.23 - 1.38); multiple-HR 1.61 (1.46 - 1.78); low-risk inpatient surgery: one-HR 1.34 (1.26 - 1.41); multiple-HR 1.69 (1.55 - 1.85); high-risk inpatient surgery: one-HR 1.14 (1.10 - 1.18); multiple-HR 1.42 (1.36 - 1.48)]. All complication types were associated with risk of death in at least 1 operative setting, and pulmonary complications, sepsis, and clostridium difficile colitis were associated with higher risk of death across all settings. Conclusions: Postoperative complications have an adverse impact on patients' long-term survival beyond the immediate postoperative period. Although most research and quality improvement initiatives primarily focus on the perioperative impact of complications, these data suggest they also have important longer-term implications that merit further investigation.
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Portuondo et al. (2021) conducted a cohort in Non-cardiac surgery (n=699,002). Postoperative complications vs. No complications was evaluated on Risk of death (HR 1.30, 95% CI 1.23 - 1.38). Postoperative complications were associated with a dose-response increase in long-term mortality across all settings (e.g., HR 1.30, 95% CI 1.23-1.38 for one complication in outpatient surgery).
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