TY - JOUR
T1 - Association between complications and death within 30 days after noncardiac surgery
AU - VISION Investigators
AU - Spence, Jessica
AU - LeManach, Yannick
AU - Chan, Matthew T.V.
AU - Wang, C. Y.
AU - Sigamani, Alben
AU - Xavier, Denis
AU - Pearse, Rupert
AU - Alonso-Coello, Pablo
AU - Garutti, Ignacio
AU - Srinathan, Sadeesh K.
AU - Duceppe, Emmanuelle
AU - Walsh, Michael
AU - Borges, Flavia Kessler
AU - Malaga, German
AU - Abraham, Valsa
AU - Faruqui, Atiya
AU - Berwanger, Otavio
AU - Biccard, Bruce M.
AU - Villar, Juan Carlos
AU - Sessler, Daniel I.
AU - Kurz, Andrea
AU - Chow, Clara K.
AU - Polanczyk, Carisi A.
AU - Szczeklik, Wojciech
AU - Ackland, Gareth
AU - Garg, Amit X.
AU - Jacka, Michael
AU - Guyatt, Gordon H.
AU - Sapsford, Robert J.
AU - Williams, Colin
AU - Cortes, Olga Lucía
AU - Coriat, Pierre
AU - Patel, Ameen
AU - Tiboni, Maria
AU - Belley-Côté, Emilie P.
AU - Yang, Stephen
AU - Heels-Ansdell, Diane
AU - McGillion, Michael
AU - Schünemann, Holger J.
AU - Parlow, Simon
AU - Patel, Matthew
AU - Pettit, Shirley
AU - Yusuf, Salim
AU - Devereaux, P. J.
N1 - Publisher Copyright:
© 2019 Joule Inc. or its licensors
PY - 2019/7/29
Y1 - 2019/7/29
N2 - BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality.
AB - BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality.
UR - http://www.scopus.com/inward/record.url?scp=85069993877&partnerID=8YFLogxK
U2 - 10.1503/cmaj.190221
DO - 10.1503/cmaj.190221
M3 - Artículo Científico
C2 - 31358597
AN - SCOPUS:85069993877
SN - 0820-3946
VL - 191
SP - E830-E837
JO - CMAJ
JF - CMAJ
IS - 30
ER -