Postoperative pulmonary (HR 2.41, 95% CI 1.30-4.48) and renal complications (HR 6.07, 95% CI 2.23-16.52) independently predicted decreased long-term survival in elderly surgical patients.
Cohort (n=517)
Do in-hospital postoperative complications reduce long-term survival in elderly patients undergoing noncardiac surgery?
In-hospital postoperative pulmonary and renal complications significantly reduce long-term survival in elderly patients undergoing noncardiac surgery.
Hazard Ratio: 2.41 (95% CI 1.3–4.48)
p-value: p=0.005
To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients ≥70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age- and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6 ± 12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio HR 2.44, 95% confidence interval CI 1.78–3.38, P II (HR 2.27, 95% CI 1.61–3.21, P < 0.0001), neurologic disease (HR 1.59, 95% CI 1.13–2.24, P = 0.008), age (HR 1.42 per decade, 95% CI 1.11–1.81, P = 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30–4.48, P = 0.005), and renal complications (HR 6.07, 95% CI 2.23–16.52, P < 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P = 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.
Manku et al. (2003) conducted a cohort in Elderly patients undergoing noncardiac surgery (n=517). Postoperative pulmonary complications vs. No postoperative pulmonary complications was evaluated on long-term survival (HR 2.41, 95% CI 1.30-4.48, p=0.005). Postoperative pulmonary (HR 2.41, 95% CI 1.30-4.48) and renal complications (HR 6.07, 95% CI 2.23-16.52) independently predicted decreased long-term survival in elderly surgical patients.