One-year outcomes after discharge from noncardiac surgery and association between pre-discharge complications and death after discharge: analysis of the VISION prospective cohort study

Roshanov PS 1 , Chan MTV 2 , Borges FK 3 , Conen D 4 , Wang CY 5 , Xavier D 6 Show all authors , Berwanger O 7 , Marcucci M 8 , Sessler DI 9 , Szczeklik W 10 , Spence J 11 , Alonso-Coello P 12 , Fernández C 13 , Pearse RM 14 , Malaga G 15 , Garg AX 16 , Srinathan SK 17 , Jacka MJ 18 , Tandon V 19 , McGillion M 20 , Popova E 21 , Sigamani A 22 , Abraham V 23 , Biccard BM 24 , Villar JC 25 , Chow CK 26 , Polanczyk CA 27 , Tiboni M 28 , Whitlock R 29 , Ackland GL 30 , Panju M 31 , Lamy A 32 , Sapsford R 33 , Williams C 34 , Wu WKK 35 , Cortés OL 36 , MacNeil SD 37 , Patel A 38 , Belley-Côté EP 39 , Ofori S 40 , McIntyre WF 41 , Leong DP 42 , Heels-Ansdell D 43 , Gregus K 44 , Devereaux PJ 45

Affiliations 

  • 1 Pavel S. Roshanov, M.D., M.Sc. Assistant Professor Department of Medicine, Western University, London, ON, Canada Population Health Research Institute, Hamilton, ON, Canada proshano@uwo.ca
  • 2 Matthew T.V. Chan, M.D., Ph.D. Professor Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, Hong Kong mtvchan@cuhk.edu.hk
  • 3 Flavia K. Borges, M.D., Ph.D. Assistant Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada flavia.borges@phri.ca
  • 4 David Conen, M.D., M.P.H. Associate Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada david.conen@phri.ca
  • 5 C.Y. Wang, M.B. Ch.B. Honorary Professor Department of Anesthesiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia wangcy@um.edu.my
  • 6 Denis Xavier, M.D., M.Sc. Professor St John's Medical College Hospital, Bangalore, Karnataka, India denis@sjri.res.in
  • 7 Otavio Berwanger, M.D., Ph.D. Professor The George Institute for Global Health, London, UK Imperial College London, London, UK otavioberwanger@gmail.com
  • 8 Maura Marcucci, M.D., M.Sc. Assistant Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada marcum2@mcmaster.ca
  • 9 Daniel I. Sessler, M.D. Michael Cudahy Professor and Chair Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA ds@or.org
  • 10 Wojciech Szczeklik, M.D., Ph.D. Professor Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Małopolska, Poland wojciech.szczeklik@uj.edu.pl
  • 11 Jessica Spence, M.D., Ph.D. Assistant Professor Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada jessicaspence13@gmail.com
  • 12 Pablo Alonso-Coello, M.D., Ph.D. Senior Researcher Iberoamerican Cochrane Center, Hospital Sant Pau, Barcelona, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain palonso@santpau.cat
  • 13 Carmen Fernández, M.D. Professor Department of Anesthesiology and Intensive Care Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Madrid, Spain carmenfriveira@gmail.com
  • 14 Rupert M. Pearse, M.D. Professor Barts and the London School of Medicine & Dentistry, Queen Mary University of London, UK r.pearse@qmul.ac.uk
  • 15 German Malaga, M.D., M.Sc. Professor Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru gmalaga01@gmail.com
  • 16 Amit X. Garg, M.D., Ph.D. Professor Department of Medicine, University of Western Ontario, London, ON, Canada amit.garg@lhsc.on.ca
  • 17 Sadeesh K. Srinathan, M.D., M.Sc. Associate Professor Department of Surgery, University of Manitoba, Winnipeg, MB, Canada ssrinathan@exchange.hsc.mb.ca
  • 18 Michael J. Jacka, M.D., M.Sc., M.B.A. Associate Professor Department of Critical Care and Anesthesia, University of Alberta, Edmonton, AB, Canada mjacka@ualberta.ca
  • 19 Vikas Tandon, M.D. Assistant Professor Department of Medicine, McMaster University, Hamilton, ON, Canada tandonv@hhsc.ca
  • 20 Michael McGillion, R.N., Ph.D. Associate Professor School of Nursing, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada mmcgill@mcmaster.ca
  • 21 Ekaterine Popova, M.D. Researcher IIB SANT PAU, Institut d'Investigació Biomèdica Sant Pau, 08041 Barcelona, Spain Centro Cochrane Iberoamericano, 08025 Barcelona, Spain epopova@santpau.cat
  • 22 Alben Sigamani, M.D., M.Sc. Founding Partner & Chief Scientific Officer Numen Health, Bangalore, Karnataka, India dralbens@numenhealth.com Narayana Hrudayalaya Health City Bangalore, Bangalore, Karnataka, India albens1227@gmail.com
  • 23 Valsa Abraham, M.D. Anesthesiologist Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India dr_valsa@yahoo.com
  • 24 Bruce M. Biccard, M.D., Ph.D. Professor and Second Chair Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Observatory, South Africa bruce.biccard@uct.ac.za
  • 25 Juan Carlos Villar, M.D., Ph.D. Associate Researcher Fundación Cardioinfantil - Instituto de Cardiología, Bogotá DC, Colombia jvillar@unab.edu.co
  • 26 Clara K. Chow, M.D., Ph.D. Professor and Academic Director Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia clara.chow@sydney.edu.au
  • 27 Carísi Anne Polanczyk, M.D., Sc.D. Associate Professor Graduate Program in Epidemiology and Cardiovascular Science, Federal University of Rio Grande do Sul, Brazil Institute for Health Technology Assessment, Porto Alegre, Rio Grande do Sul, Brazil carisi.anne@gmail.com
  • 28 Maria Tiboni, M.D. Associate Professor Department of Medicine, McMaster University, Hamilton, ON, Canada mtiboni@stjosham.on.ca
  • 29 Richard Whitlock, M.D., Ph.D. Professor Department of Surgery, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada richard.whitlock@phri.ca
  • 30 Gareth L. Ackland, M.D., Ph.D. Clinical Professor of Perioperative Medicine William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom g.ackland@qmul.ac.uk
  • 31 Mohamed Panju, M.Sc., M.D. Associate Professor Department of Medicine, McMaster University, Hamilton, ON, Canada mohamed.panju@medportal.ca
  • 32 André Lamy, M.D., M.HSc. Professor Department of Surgery, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada lamya@mcmaster.ca
  • 33 Robert Sapsford, M.D. Consultant Cardiologist Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, Leeds, United Kingdom r.sapsford@nhs.net
  • 34 Colin Williams, M.D. Consultant Anesthetist Royal Liverpool University Hospital, Liverpool, Liverpool, United Kingdom Colin.Williams@liverpoolft.nhs.uk
  • 35 William Ka Kei Wu, Ph.D. Associate Professor Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, New Territories, Hong Kong wukakei@cuhk.edu.hk
  • 36 Olga Lucía Cortés, R.N., Ph.D. Associate Researcher Research Department and Nursing Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá DC, Colombia olgacortesf@gmail.com
  • 37 S. Danielle MacNeil, M.D., M.Sc. Assistant Professor Schulich School of Medicine and Dentistry, Western University, London, ON, Canada Otolaryngology - Head & Neck Surgery, London Health Sciences Centre, London, ON, Canada Danielle.MacNeil@lhsc.on.ca
  • 38 Ameen Patel, M.B. Professor Department of Medicine, McMaster University, Hamilton, ON, Canada patela@mcmaster.ca
  • 39 Emilie P. Belley-Côté, M.D., Ph.D. Assistant Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada emilie.belley-cote@phri.ca
  • 40 Sandra Ofori, M.D. Investigator Population Health Research Institute, Hamilton, ON, Canada Department of Medicine, McMaster University, Hamilton, ON, Canada sandra.ofori@phri.ca
  • 41 William F. McIntyre, M.D., Ph.D. Assistant Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada william.mcintyre@phri.ca
  • 42 Darryl P. Leong, M.B.B.S, M.P.H, Ph.D. Associate Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada leongd@phri.ca
  • 43 Diane Heels-Ansdell, M.Sc. Assistant Professor Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada ansdell@mcmaster.ca
  • 44 Krysten Gregus, R.N. Research Assistant Population Health Research Institute, Hamilton, ON, Canada gregus@HHSC.CA
  • 45 P.J. Devereaux, M.D., Ph.D. Professor Department of Medicine, McMaster University, Hamilton, ON, Canada Population Health Research Institute, Hamilton, ON, Canada pj.devereaux@phri.ca
Anesthesiology, 2023 Sep 15.
PMID: 37713506 DOI: 10.1097/ALN.0000000000004763

Abstract

BACKGROUND: In prior 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. We set out to describe outcomes after discharge from hospital up to one year after inpatient noncardiac surgery and associations between pre-discharge complications and post-discharge death up to one year after surgery.

METHODS: Analysis of patients discharged after inpatient noncardiac surgery in a large international prospective cohort study across 28 centers from 2007-2013 of patients aged ≥45 years followed to one year after surgery. We estimated 1) the cumulative post-discharge incidence of death and other outcomes up to a year after surgery and 2) the adjusted time-varying associations between post-discharge death and pre-discharge 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 one-year incidence was 5.8% (95% CI, 5.5-6.0%) for all-cause death and 24.7% (24.2-25.1%) for all-cause hospital readmission. Pre-discharge complications were associated with 33.7% (27.2-40.2%) of deaths up to 30 days after discharge and 15.0% (12.0-17.9%) up to one year. Most of the association with death was due to myocardial injury after noncardiac surgery (15.6% [9.3-21.9%) of deaths within 30 days, 6.4% [4.1-8.7%] within one year), major bleeding (15.0% [8.3-21.7%] within 30 days, 4.7% [2.2-7.2%] within one year), and sepsis (5.4% [2.2-8.6%] within 30 days, 2.1% [1.0-3.1%] within one year).

CONCLUSIONS: One in 18 patients ≥45 years old discharged after inpatient noncardiac surgery died within one year and one quarter were readmitted to hospital. The risk of death associated with pre-discharge perioperative complications persists for weeks to months after discharge.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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