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Survival after postoperative morbidity: a longitudinal observational cohort study
S R Moonesinghe1, S Harris2, M G Mythen3
1UCL/UCLH Surgical Outcomes Research Centre, Department of Anaesthetics, University College Hospital, London NW1 2BU, UK UCL Centre for Anaesthesia, University College Hospital, London NW1 2BU, UK National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, 35 Red Lion Square, London WC1R 4SG, UK rmoonesinghe@gmail.com.
British Journal of Anaesthesia
|July 12, 2014
Summary
Prolonged postoperative morbidity after major surgery increases long-term mortality risk. This elevated risk persists for years but gradually declines over time, highlighting the need for better complication management.
Area of Science:
- Surgical Outcomes Research
- Patient Safety
- Clinical Epidemiology
Background:
- Previous research suggests long-term harm from postoperative complications.
- Existing studies face challenges due to the need for risk adjustment and inconsistent definitions of postoperative morbidity.
Purpose of the Study:
- To investigate the independent relationship between prolonged postoperative morbidity and longer-term survival.
- To assess the duration of increased mortality risk associated with postoperative complications.
Main Methods:
- Longitudinal observational cohort study of 1362 patients undergoing major surgery.
- Application of case-mix adjustment and a validated outcome measure for morbidity.
- Cox proportional hazards modeling with time-dependent covariates to analyze survival.
Main Results:
- Postoperative neurological morbidity (2.9%) was linked to a 2.00-fold increased hazard for long-term mortality.
- Prolonged postoperative morbidity (15.6%) significantly elevated mortality risk: 3.51-fold within 12 months and 2.44-fold for the subsequent 2 years.
- The increased mortality risk associated with prolonged morbidity returned to baseline after the initial period.
Conclusions:
- Prolonged postoperative morbidity is associated with a longer duration of premature death risk than commonly perceived.
- The study suggests prolonged postoperative morbidity can serve as a valid indicator of surgical healthcare quality.
- Findings emphasize the importance of research and quality improvement to reduce postoperative complication severity and duration.
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