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

Roshanov, Pavel S. and Chan, Matthew T. V. and Borges, Flavia K. and Conen, David and Wang, Chew Yin and Xavier, Denis and Berwanger, Otavio and Marcucci, Maura and Sessler, Daniel I. and Szczeklik, Wojciech and Spence, Jessica and Alonso-Coello, Pablo and Fernández, Carmen and Pearse, Rupert M. and Malaga, German and Garg, Amit X. and Srinathan, Sadeesh K. and Jacka, Michael J. and Tandon, Vikas and McGillion, Michael and Popova, Ekaterine and Sigamani, Alben and Abraham, Valsa and Biccard, Bruce M. and Villar, Juan Carlos and Chow, Clara K. and Polanczyk, Carísi A. and Tiboni, Maria and Whitlock, Richard and Ackland, Gareth L. and Panju, Mohamed and Lamy, André and Sapsford, Robert and Williams, Colin and Wu, William Ka Kei and Cortés, Olga L. and Macneil, S. Danielle and Patel, Ameen and Belley-Côté, Emilie P. and Ofori, Sandra and McIntyre, William F. and Leong, Darryl P. and Heels-Ansdell, Diane and Gregus, Krysten and Devereaux, P.J. (2024) One-year outcomes after discharge from noncardiac surgery and association between predischarge complications and death after discharge: Analysis of the VISION prospective cohort study. Anesthesiology, 140 (1). 8 – 24. ISSN 0003-3022, DOI

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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. © 2024 Lippincott Williams and Wilkins. All rights reserved.

Item Type: Article
Funders: Academic Health Science Centers Alternative Funding Plan Innovation Fund Ontario, Diagnostic Services of Manitoba Research, Father Sean O’Sullivan Research Center
Uncontrolled Keywords: Aftercare; Hemorrhage; Humans; Patient discharge; Postoperative complications; Prospective studies; Risk factors; Sepsis; Insulin; Acute kidney failure; Adult; Aged; All cause mortality; Amputation; Article; Atrial fibrillation; Cerebrovascular accident; Cohort analysis; Congestive heart failure; Diabetes mellitus; Female; Heart atrium flutter; Heart muscle injury; Hospital discharge; Hospital patient; Hospital readmission; Hospitalization
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine > Anaesthesiology Department
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 01 Apr 2024 05:24
Last Modified: 01 Apr 2024 05:24

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