Portuondo Jorge I, Itani Kamal M F, Massarweh Nader N
Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas.
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Surg. 2023 Jan 1;277(1):e24-e32. doi: 10.1097/SLA.0000000000004749. Epub 2021 Jan 15.
To evaluate the relationship between postoperative complications and long-term survival.
Postoperative complications remain a significant driver of healthcare costs and are associated with increased perioperative mortality, yet the extent to which they are associated with long-term survival is unclear.
National cohort study of Veterans who underwent non-cardiac surgery using data from the Veterans Affairs Surgical Quality Improvement Program (2011-2016). Patients were classified as having undergone outpatient, low-risk inpatient, or high-risk inpatient surgery. Patients were categorized based on number and type of complications. The association between the number of complications (or the specific type of complication) and risk of death was evaluated using multivariable Cox regression with robust standard errors using a 90-day survival landmark.
Among 699,002 patients, complication rates were 3.0%, 6.1%, and 18.3% for outpatient, low-risk inpatient, and high-risk inpatient surgery, respectively. There was a dose-response relationship between an increasing number of complications and overall risk of death in all operative settings [outpatient surgery: no complications (ref); one-hazard ratio (HR) 1.30 (1.23 - 1.38); multiple-HR 1.61 (1.46 - 1.78); low-risk inpatient surgery: one-HR 1.34 (1.26 - 1.41); multiple-HR 1.69 (1.55 - 1.85); high-risk inpatient surgery: one-HR 1.14 (1.10 - 1.18); multiple-HR 1.42 (1.36 - 1.48)]. All complication types were associated with risk of death in at least 1 operative setting, and pulmonary complications, sepsis, and clostridium difficile colitis were associated with higher risk of death across all settings. Conclusions: Postoperative complications have an adverse impact on patients' long-term survival beyond the immediate postoperative period. Although most research and quality improvement initiatives primarily focus on the perioperative impact of complications, these data suggest they also have important longer-term implications that merit further investigation.
评估术后并发症与长期生存之间的关系。
术后并发症仍然是医疗成本的重要驱动因素，并且与围手术期死亡率增加相关，但它们与长期生存的关联程度尚不清楚。
利用退伍军人事务部外科质量改进计划（2011 - 2016年）的数据，对接受非心脏手术的退伍军人进行全国队列研究。患者被分类为接受门诊手术、低风险住院手术或高风险住院手术。患者根据并发症的数量和类型进行分类。使用多变量Cox回归和稳健标准误，以90天生存为界标，评估并发症数量（或特定并发症类型）与死亡风险之间的关联。
在699,002例患者中，门诊手术、低风险住院手术和高风险住院手术的并发症发生率分别为3.0%、6.1%和18.3%。在所有手术环境中，并发症数量增加与总体死亡风险之间存在剂量反应关系[门诊手术：无并发症（参照）；一种并发症 - 风险比（HR）1.30（1.23 - 1.38）；多种并发症 - HR 1.61（1.46 - 1.78）；低风险住院手术：一种并发症 - HR 1.34（1.26 - 1.41）；多种并发症 - HR 1.69（1.55 - 1.85）；高风险住院手术：一种并发症 - HR 1.14（1.10 - 1.18）；多种并发症 - HR 1.42（1.36 - 1.48）]。所有并发症类型在至少一种手术环境中与死亡风险相关，并且肺部并发症、脓毒症和艰难梭菌结肠炎在所有环境中与更高的死亡风险相关。结论：术后并发症对患者术后即刻以外的长期生存有不利影响。尽管大多数研究和质量改进举措主要关注并发症的围手术期影响，但这些数据表明它们也有重要的长期影响，值得进一步研究。
