One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study-Reference-Cited by-同舟云学术

One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study

Published:2023-09-15 Issue:1 Volume:140 Page:8-24
ISSN:0003-3022
Container-title:Anesthesiology
language:en
Short-container-title:

Author:

Roshanov Pavel S.¹^ORCID,Chan Matthew T. V.²,Borges Flavia K.³,Conen David⁴,Wang C. Y.⁵,Xavier Denis⁶,Berwanger Otavio⁷,Marcucci Maura⁸,Sessler Daniel I.⁹,Szczeklik Wojciech¹⁰,Spence Jessica¹¹,Alonso-Coello Pablo¹²,Fernández Carmen¹³,Pearse Rupert M.¹⁴,Malaga German¹⁵,Garg Amit X.¹⁶,Srinathan Sadeesh K.¹⁷,Jacka Michael J.¹⁸,Tandon Vikas¹⁹,McGillion Michael²⁰,Popova Ekaterine²¹,Sigamani Alben²²,Abraham Valsa²³,Biccard Bruce M.²⁴,Villar Juan Carlos²⁵,Chow Clara K.²⁶,Polanczyk Carísi A.²⁷,Tiboni Maria²⁸,Whitlock Richard²⁹^ORCID,Ackland Gareth L.³⁰,Panju Mohamed³¹,Lamy André³²,Sapsford Robert³³,Williams Colin³⁴,Wu William Ka Kei³⁵,Cortés Olga L.³⁶,MacNeil S. Danielle³⁷,Patel Ameen³⁸,Belley-Côté Emilie P.³⁹,Ofori Sandra⁴⁰,McIntyre William F.⁴¹,Leong Darryl P.⁴²,Heels-Ansdell Diane⁴³,Gregus Krysten⁴⁴,Devereaux P. J.⁴⁵

Affiliation:

1. 1Department of Medicine, Western University, London, Canada; Population Health Research Institute, Hamilton, Canada.

2. 2Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, Hong Kong.

3. 3Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

4. 4Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

5. 5Honorary Professor; Department of Anesthesiology, University of Malaya, Kuala Lumpur, Malaysia.

6. 6St. John’s Medical College Hospital, Bangalore, India.

7. 7George Institute for Global Health, London, United Kingdom; Imperial College London, London, United Kingdom.

8. 8Clinical Epidemiology and Research Centre (CERC), Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.

9. 9Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.

10. 10Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.

11. 11Anesthesia and Critical Care, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

12. 12Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública, Madrid, Spain.

13. 13Department of Anesthesiology and Intensive Care Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

14. 14Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.

15. 15Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.

16. 16Department of Medicine, University of Western Ontario, London, Canada.

17. 17Department of Surgery, University of Manitoba, Winnipeg, Canada.

18. 18Department of Critical Care and Anesthesia, University of Alberta, Edmonton, Canada.

19. 19Department of Medicine, McMaster University, Hamilton, Canada.

20. 20School of Nursing, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

21. 21IIB Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain; Centro Cochrane Iberoamericano, Barcelona, Spain.

22. 22Numen Health, Bangalore, India; Narayana Hrudayalaya Health City Bangalore, Bangalore, India.

23. 23Christian Medical College and Hospital Ludhiana, Ludhiana, India.

24. 24Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, South Africa.

25. 25Fundación Cardioinfantil–Instituto de Cardiología, Bogotá DC, Colombia.

26. 26Westmead Applied Research Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia.

27. 27Graduate Program in Epidemiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Institute for Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil.

28. 28Department of Medicine, McMaster University, Hamilton, Canada.

29. 29Department of Surgery, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

30. 30William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.

31. 31Department of Medicine, McMaster University, Hamilton, Canada.

32. 32Department of Surgery, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

33. 33Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.

34. 34Royal Liverpool University Hospital, Liverpool, United Kingdom.

35. 35Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, New Territories, Hong Kong.

36. 36Research Department and Nursing Department, Fundación Cardioinfantil–Instituto de Cardiología, Bogotá DC, Colombia.

37. 37Schulich School of Medicine and Dentistry, Western University, London, Canada; Otolaryngology–Head & Neck Surgery, London Health Sciences Centre, London, Canada.

38. 38Department of Medicine, McMaster University, Hamilton, Canada.

39. 39Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

40. 40Population Health Research Institute, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada.

41. 41Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

42. 42Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

43. 43Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada.

44. 44Population Health Research Institute, Hamilton, Canada.

45. 45Department of Medicine, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada.

Abstract

Background In previous analyses, myocardial injury after noncardiac surgery, major bleeding, and sepsis were independently associated with most deaths in the 30 days after noncardiac surgery, but most of these deaths occurred during the index hospitalization for surgery. The authors set out to describe outcomes after discharge from hospital up to 1 yr after inpatient noncardiac surgery and associations between predischarge complications and postdischarge death up to 1 yr after surgery. Methods This study was an analysis of patients discharged after inpatient noncardiac surgery in a large international prospective cohort study across 28 centers from 2007 to 2013 of patients aged 45 yr or older followed to 1 yr after surgery. The study estimated (1) the cumulative postdischarge incidence of death and other outcomes up to a year after surgery and (2) the adjusted time-varying associations between postdischarge death and predischarge complications including myocardial injury after noncardiac surgery, major bleeding, sepsis, infection without sepsis, stroke, congestive heart failure, clinically important atrial fibrillation or flutter, amputation, venous thromboembolism, and acute kidney injury managed with dialysis. Results Among 38,898 patients discharged after surgery, the cumulative 1-yr incidence was 5.8% (95% CI, 5.5 to 6.0%) for all-cause death and 24.7% (95% CI, 24.2 to 25.1%) for all-cause hospital readmission. Predischarge complications were associated with 33.7% (95% CI, 27.2 to 40.2%) of deaths up to 30 days after discharge and 15.0% (95% CI, 12.0 to 17.9%) up to 1 yr. Most of the association with death was due to myocardial injury after noncardiac surgery (15.6% [95% CI, 9.3 to 21.9%] of deaths within 30 days, 6.4% [95% CI, 4.1 to 8.7%] within 1 yr), major bleeding (15.0% [95% CI, 8.3 to 21.7%] within 30 days, 4.7% [95% CI, 2.2 to 7.2%] within 1 yr), and sepsis (5.4% [95% CI, 2.2 to 8.6%] within 30 days, 2.1% [95% CI, 1.0 to 3.1%] within 1 yr). Conclusions One in 18 patients 45 yr old or older discharged after inpatient noncardiac surgery died within 1 yr, and one quarter were readmitted to the hospital. The risk of death associated with predischarge perioperative complications persists for weeks to months after discharge. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Link

https://pubs.asahq.org/anesthesiology/article-pdf/140/1/8/698786/20240100.0-00009.pdf

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