DOI: 10.1097/01.SA.0000460965.14094.8d
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Issn Print: 0039-6206
Publication Date: 2015/04/01
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Excerpt
The primary objective was to measure the independent relationships between perioperative risk, inpatient postoperative morbidity, and long-term survival. Patients having elective, major noncardiac or nonneurologic surgery were recruited between 2001 and 2005. Patient data included age, surgical procedure, surgical specialty, and measures of perioperative risk. Mortality was determined at hospital discharge, 30 days, and 1 and 5 years after operative date. Case-mix adjustment was applied, and morbidity was recorded via a validated outcome measure; Kaplan-Meier plots were used to measure the relationship between categorical variables and long-term survival. All statistical analyses were performed using STATA InterCooled version 12.1 software (StataCorp LP, College Station, Tex).
The 2 cohorts included 1362 patients and were similar in age, sex, American Society of Anesthesiologists physical status score, and the distribution of surgical specialties The median length of hospital stay was 9 days (interquartile range, 6–14 days). Follow-up data were analyzed for 1342 patients (data were missing on 13 patients, and 7 died within 15 days of surgery). Most patients (79%) were having noncancer surgery and had no sign of malignancy at the time of surgery. In the final group, 383 patients died (28.1%). The maximum duration of follow-up was 3895 days (10.7 years), with a median follow-up of 2375 days (6.5 years; interquartile range, 2696–2899 days). Mortality rates for inpatients (n = 1362), at 30 days (n = 1362), at 1 year (n = 1347), and at 5 years (n = 1339), were 1.5%, 1.1%, 6.8%, and 20.7%, respectively. The occurrence of postoperative morbidity of any etiology was associated with reduced long-term survival (P < 0.001). The perioperative risk factors of age, cancer history, predicted risk based on the Portsmouth Physiology and Operative Severity Score for the Enumeration of Morbidity and Mortality, and the procedure categories of general or vascular surgery were independently associated with reduced long-term survival. The occurrence of postoperative neurologic morbidity (prevalence, 2.94%) was associated with a relative hazard for long-term mortality of 2.00 (P = 0.001; 95% confidence interval [CI], 1.32–3.04). Morbidity that lasted 15 days or more was associated with a relative hazard of 3.51 (95% CI, 2.28–5.42) for the first year after surgery and 2.44 for the next 2 years (95% CI, 1.62–3.65); it returned to baseline thereafter.
Prolonged postoperative morbidity is associated with an increased risk of death for up to 3 years postoperatively, which indicates that this is a major public health issue. Prolonged postoperative morbidity is a valid and important quality metric for evaluating perioperative car, and reducing such morbidity should be a priority within the health care system.
