Perioperative Complications are Associated With Adverse Long-Term Prognosis and Affect the Cause of Death After General Surgery.
It is unclear how mortality and causes of death vary between patients and surgical procedures and how occurrence of postoperative complications is associated with prognosis. This study describes long-term mortality rates and causes of death in a general surgical population. Furthermore, we explore the effect of postoperative complications on mortality.



A single-centre analysis of postoperative complications, with mortality as primary endpoint, was conducted in 4479 patients undergoing surgery. We applied univariate and multivariable regression models to analyse the effect of risk factors, including surgical risk and postoperative complications, on mortality. Causes of death were also explored.



75 patients (1.7 %) died within 30 days after surgery and 730 patients (16.3 %) died during a median follow-up of 6.3 years (IQR 5.8-6.8). Significant differences in long-term mortality were observed with worst outcome for patients undergoing high-risk vascular surgery (HR 1.5; 95 % CI 1.2-1.9). When looking at causes of death, high-risk surgery was associated with a twofold higher risk of cardiovascular death (HR 1.9; 95 % CI 1.2-3.1), whereas the intermediate-risk group had a higher risk of dying from cancer-related causes (HR 1.5; 95 % CI 1.1-2.0). Occurrence of complications-particularly of cardiovascular nature- was associated with worse survival (HR 1.9; 95 % CI 1.3-2.7).



High-risk vascular surgery and occurrence of postoperative complications are important predictors of late mortality. Further focus on these groups of patients can contribute to reduced morbidity. Improvement in quality of care should be aimed at preventing postoperative complications and thus a better outcome in a general surgical population.
Department of Anesthesiology, Erasmus University Medical Centre, Room H-1273, PO Box 2040 3000, CA, Rotterdam, The Netherlands. e.tjeertes@erasmusmc.nl.
Elke K M
EK
Tjeertes
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
K H J
KH
Ultee
Department of Anesthesiology, Erasmus University Medical Centre, Room H-1273, PO Box 2040 3000, CA, Rotterdam, The Netherlands.
R J
RJ
Stolker
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
H J M
HJ
Verhagen
Department of Vascular Surgery, Hospital de Santa Marta, Lisbon, Portugal.
F M
FM
Bastos Gonçalves
Department of Surgery, Zuyderland Medical Centre, Sittard, The Netherlands.
A G M
AG
Hoofwijk
Department of Anesthesiology, Erasmus University Medical Centre, Room H-1273, PO Box 2040 3000, CA, Rotterdam, The Netherlands.
S E
SE
Hoeks
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000401:mortality*