Changes in prognosis after the first postoperative complication.
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.
Silber
Jeffrey H
JH
The Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. silberj@wharton.upenn.edu
Rosenbaum
Paul R
PR
Trudeau
Martha E
ME
Chen
Wei
W
Zhang
Xuemei
X
Kelz
Rachel Rapaport
RR
Mosher
Rachel E
RE
Even-Shoshan
Orit
O
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