title: Changes in prognosis after the first postoperative complication.
abstract: BACKGROUND
  Postoperative complications are common in the Medicare population, yet no study has formally quantified the change in prognosis that occurs after a broad range of first complications.
  
  
  OBJECTIVE
  We sought to estimate the relative severity of 24 first postoperative complications.
  
  
  METHODS
  We undertook a multivariate matched, population-based, case-control study of death after surgery in a sample of 1362 Pennsylvania Medicare patients.
  
  
  METHODS
  Cases (681 deaths) were selected randomly using claims from 1995-1996. Models were developed to scan all Pennsylvania claims, looking for similar controls that did not die.
  
  
  METHODS
  Charts were abstracted, complications identified, and models were constructed to estimate the odds of dying after any 1 of 24 first postoperative complications.
  
  
  RESULTS
  The odds of dying within 60 days increased 3.4-fold (95% confidence interval [CI] 2.5-4.7) in patients with complications as compared with those without complications. A first complication of respiratory compromise was associated with a 7.2-fold increase in the odds of dying (95% CI 4.5-11.6). The first complications of pneumonia or congestive heart failure were associated with, respectively, 5-fold (95% CI 2.1-12.1) and 5.1-fold (2.3-11.1) increases in odds of dying as compared with no complication.
  
  
  CONCLUSIONS
  First complications after surgery, even seemingly mild ones, may radically alter the patient's risk of death. First complications often begin the cascade of complications that end in death. Caregivers should consider the first complication as a timely signal of a changed clinical situation demanding a reevaluation of the patient's care. Researchers may use these estimates to determine the relative severity of a broad range of first or early complications.
authors.affiliation: The Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. silberj@wharton.upenn.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Silber
authors.forename: Paul R
authors.initials: PR
authors.lastname: Rosenbaum
authors.forename: Martha E
authors.initials: ME
authors.lastname: Trudeau
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Xuemei
authors.initials: X
authors.lastname: Zhang
authors.forename: Rachel Rapaport
authors.initials: RR
authors.lastname: Kelz
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Mosher
authors.forename: Orit
authors.initials: O
authors.lastname: Even-Shoshan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology; D012140:Respiratory Tract Diseases / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D014882:Water-Electrolyte Balance