RT Journal Article
SR Electronic
T1 Association between complications and death within 30 days after noncardiac surgery
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E830
OP E837
DO 10.1503/cmaj.190221
VO 191
IS 30
A1 The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators
A1 Jessica Spence
A1 Yannick LeManach
A1 Matthew T.V. Chan
A1 C.Y. Wang
A1 Alben Sigamani
A1 Denis Xavier
A1 Rupert Pearse
A1 Pablo Alonso-Coello
A1 Ignacio Garutti
A1 Sadeesh K Srinathan
A1 Emmanuelle Duceppe
A1 Michael Walsh
A1 Flavia Kessler Borges
A1 German Malaga
A1 Valsa Abraham
A1 Atiya Faruqui
A1 Otavio Berwanger
A1 Bruce M. Biccard
A1 Juan Carlos Villar
A1 Daniel I. Sessler
A1 Andrea Kurz
A1 Clara K. Chow
A1 Carisi A. Polanczyk
A1 Wojciech Szczeklik
A1 Gareth Ackland
A1 Garg Amit X.
A1 Michael Jacka
A1 Gordon H. Guyatt
A1 Robert J. Sapsford
A1 Colin Williams
A1 Olga Lucía Cortes
A1 Pierre Coriat
A1 Ameen Patel
A1 Maria Tiboni
A1 Emilie P. Belley-Côté
A1 Stephen Yang
A1 Diane Heels-Ansdell
A1 Michael McGillion
A1 Holger J. Schünemann
A1 Simon Parlow
A1 Matthew Patel
A1 Shirley Pettit
A1 Salim Yusuf
A1 P.J. Devereaux
A1 ,
YR 2019
UL http://www.cmaj.ca/content/191/30/E830.abstract
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 40 004 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. Study registration: ClinicalTrials.gov, no. NCT00512109.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.190882