Survival after postoperative morbidity: a longitudinal observational cohort study

被引:112
作者
Moonesinghe, S. R. [1 ,2 ,3 ]
Harris, S. [2 ,4 ]
Mythen, M. G. [1 ,2 ]
Rowan, K. M. [5 ]
Haddad, F. S. [1 ,6 ]
Emberton, M. [1 ,7 ]
Grocott, M. P. W. [1 ,3 ,8 ,9 ]
机构
[1] Univ Coll London Hosp, Dept Anaesthet, UCL UCLH Surg Outcomes Res Ctr, London NW1 2BU, England
[2] Univ Coll London Hosp, UCL Ctr Anaesthesia, London NW1 2BU, England
[3] Royal Coll Anaesthetists, Natl Inst Acad Anaesthesias Hlth Serv Res Ctr, London WC1R 4SG, England
[4] Univ London London Sch Hyg & Trop Med, London WC1E 7HT, England
[5] Intens Care Natl Audit & Res Ctr, London WC1V 6AZ, England
[6] UCL, Inst Sports Exercise & Hlth, London WC1E 6BT, England
[7] UCL, Div Surg & Intervent Sci, London WC1E 6BT, England
[8] Univ Southampton, Integrat Physiol & Crit Illness Grp, Southampton, Hants, England
[9] Univ Hosp Southampton NHS Fdn Trust, Anaesthesia & Crit Care Res Unit, Southampton, Hants, England
关键词
complications; morbidity; neurological; surgery; non-cardiac; MAJOR SURGERY; COGNITIVE DYSFUNCTION; MORTALITY; RISK; COMPLICATIONS; POSSUM; CLASSIFICATION; METAANALYSIS; MODERATE; OUTCOMES;
D O I
10.1093/bja/aeu224
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background. Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. Methods. We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. Results. Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32-3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62-3.65), returning to baseline thereafter. Conclusions. Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications.
引用
收藏
页码:977 / 984
页数:8
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