title: Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.
abstract: OBJECTIVE
  The objective of this study was to identify the determinants of 30-day postoperative mortality and long-term survival after major surgery as exemplified by 8 common operations.
  
  
  BACKGROUND
  The National Surgical Quality Improvement Program (NSQIP) database contains pre-, intra-, and 30-day postoperative data, prospectively collected in a standardized fashion by a dedicated nurse reviewer, on major surgery in the Veterans Administration (VA). The Beneficiary Identification and Records Locator Subsystem (BIRLS) is a VA file that depicts the vital status of U.S. veterans with 87% to 95% accuracy.
  
  
  METHODS
  NSQIP data were merged with BIRLS to determine the vital status of 105,951 patients who underwent 8 types of operations performed between 1991 and 1999, providing an average follow up of 8 years. Logistic and Cox regression analyses were performed to identify the predictors of 30-day mortality and long-term survival, respectively.
  
  
  RESULTS
  The most important determinant of decreased postoperative survival was the occurrence, within 30 days postoperatively, of any one of 22 types of complications collected in the NSQIP. Independent of preoperative patient risk, the occurrence of a 30-day complication in the total patient group reduced median patient survival by 69%. The adverse effect of a complication on patient survival was also influenced by the operation type and was sustained even when patients who did not survive for 30 days were excluded from the analyses.
  
  
  CONCLUSIONS
  The occurrence of a 30-day postoperative complication is more important than preoperative patient risk and intraoperative factors in determining the survival after major surgery in the VA. Quality and process improvement in surgery should be directed toward the prevention of postoperative complications.
authors.affiliation: Departments of Surgery, VA Boston Healthcare System, MA 02132, USA. shukri.khuri@med.va.gov
authors.forename: Shukri F
authors.initials: SF
authors.lastname: Khuri
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Ralph G
authors.initials: RG
authors.lastname: DePalma
authors.forename: Cecilia
authors.initials: C
authors.lastname: Mosca
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Healey
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
mesh_terms: D019992:Databases as Topic; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology