Park Lily J, Borges Flavia K, Ofori Sandra, Nenshi Rahima, Jacka Michael, Heels-Ansdell Diane, Bogach Jessica, Vogt Kelly, Chan Matthew Tv, Verghese Anish, Polanczyk Carisi A, Skinner David, Asencio J M, Paniagua Pilar, Rosen Michael, Serrano Pablo E, Marcaccio Michael J, Simunovic Marko, Thabane Lehana, Devereaux P J
Population Health Research Institute, Hamilton, ON, Canada.
Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
Ann Surg. 2024 Jun 11. doi: 10.1097/SLA.0000000000006372.
To determine the epidemiology of post-operative complications among general surgery patients, inform their relationships with 30-day mortality, and determine the attributable fraction of death of each postoperative complication.
The contemporary causes of post-operative mortality among general surgery patients are not well characterized.
VISION is a prospective cohort study of adult non-cardiac surgery patients across 28 centres in 14 countries, who were followed for 30 days after surgery. For the subset of general surgery patients, a cox proportional hazards model was used to determine associations between various surgical complications and post-operative mortality. The analyses were adjusted for preoperative and surgical variables. Results were reported in adjusted hazard ratios (HR) with 95% confidence intervals (CI).
Among 7950 patients included in the study, 240 (3.0%) patients died within 30 days of surgery. Five post-operative complications (myocardial injury after non-cardiac surgery [MINS], major bleeding, sepsis, stroke, and acute kidney injury resulting in dialysis) were independently associated with death. Complications associated with the largest attributable fraction (AF) of post-operative mortality (i.e., percentage of deaths in the cohort that can be attributed to each complication, if causality were established) were major bleeding (n=1454, 18.3%, HR 2.49 95%CI 1.87-3.33, P<0.001, AF 21.2%), sepsis (n=783, 9.9%, HR 6.52, 95%CI 4.72-9.01, P<0.001, AF 15.6%), and MINS (n=980, 12.3%, HR 2.00, 95%CI 1.50-2.67, P<0.001, AF 14.4%).
The complications most associated with 30-day mortality following general surgery are major bleeding, sepsis, and MINS. These findings may guide the development of mitigating strategies, including prophylaxis for perioperative bleeding.
确定普通外科手术患者术后并发症的流行病学情况，了解其与30天死亡率的关系，并确定每种术后并发症的死亡归因比例。
普通外科手术患者术后死亡的当代原因尚未得到充分描述。
VISION是一项对14个国家28个中心的成年非心脏手术患者进行的前瞻性队列研究，术后对患者进行30天随访。对于普通外科手术患者子集，使用Cox比例风险模型确定各种手术并发症与术后死亡率之间的关联。分析对术前和手术变量进行了调整。结果以调整后的风险比（HR）及95%置信区间（CI）报告。
在纳入研究的7950例患者中，240例（3.0%）在术后30天内死亡。五种术后并发症（非心脏手术后心肌损伤[MINS]、大出血、脓毒症、中风以及导致透析的急性肾损伤）与死亡独立相关。与术后死亡率归因比例最大（即，如果确定因果关系，队列中可归因于每种并发症的死亡百分比）相关的并发症为大出血（n = 1454，18.3%，HR 2.49，95%CI 1.87 - 3.33，P < 0.001，AF 21.2%）、脓毒症（n = 783，9.9%，HR 6.52，95%CI 4.72 - 9.01，P < 0.001，AF 15.6%）和MINS（n = 980，12.3%，HR 2.00，95%CI 1.50 - 2.67，P < 0.001，AF 14.4%）。
普通外科手术后与30天死亡率最相关的并发症是大出血、脓毒症和MINS。这些发现可能指导缓解策略的制定，包括围手术期出血的预防。
