Prognostic significance of postoperative in-hospital complications in elderly patients. I. Long-term survival.
To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients > or = 70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age- and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6 +/- 12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.78-3.38, P < 0.0001), ASA physical status >II (HR 2.27, 95% CI 1.61-3.21, P < 0.0001), neurologic disease (HR 1.59, 95% CI 1.13-2.24, P = 0.008), age (HR 1.42 per decade, 95% CI 1.11-1.81, P = 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30-4.48, P = 0.005), and renal complications (HR 6.07, 95% CI 2.23-16.52, P < 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P = 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.
Manku
Kawalpreet
K
Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA.
Bacchetti
Peter
P
Leung
Jacqueline M
JM
D000367:Age Factors; D000368:Aged / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D044469:Racial Groups; D018570:Risk Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis