title: Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival.
abstract: BACKGROUND
  Major surgery is associated with high rates of postoperative complications, many of which are deemed preventable. It has been suggested that these complications not only present a risk to patients in the short term, but may also reduce long-term survival. The aim of this review was to examine the effects of postoperative complications on long-term survival.
  
  
  METHODS
  MEDLINE, Web of Science and reference lists of relevant articles were searched up to July 2013. Studies assessing only procedure-specific, or technical failure-related, complications were excluded, as were studies of poor methodological quality. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using funnel plots.
  
  
  RESULTS
  Eighteen eligible studies were included, comprising results for 134 785 patients with an overall complication rate of 22·6 (range 10·6-69) per cent. The studies included operations for both benign and malignant disease. Median follow-up was 43 (range 28-96) months. Meta-analysis demonstrated reduced overall survival after any postoperative complication for ten studies with eligible data (20 755 patients), with a hazard ratio (HR) of 1·28 (95 per cent confidence interval 1·21 to 1·34). Similar results were found for overall survival following infectious complications: HR 1·92 (1·50 to 2·35). In analyses of disease-free survival the HR was 1·26 (1·10 to 1·42) for all postoperative complications and 1·55 (1·12 to 1·99) for infectious complications. Inclusion of poor-quality studies in a sensitivity analysis had no effect on the results.
  
  
  CONCLUSIONS
  Postoperative complications have a negative effect on long-term survival. This relationship appears to be stronger for infectious complications.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: P H
authors.initials: PH
authors.lastname: Pucher
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: M
authors.initials: M
authors.lastname: Qurashi
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D004812:Epidemiologic Methods; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis