Association between Complications and Death within 30 days after General Surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) substudy

Lily J Park; Flavia K Borges; Sandra Ofori; Rahima Nenshi; Michael Jacka; Diane Heels-Ansdell; Jessica Bogach; Kelly Vogt; Matthew Tv Chan; Anish Verghese; Carisi A Polanczyk; David Skinner; J M Asencio; Pilar Paniagua; Michael Rosen; Pablo E Serrano; Michael J Marcaccio; Marko Simunovic; Lehana Thabane; P J Devereaux

doi:10.1097/SLA.0000000000006372

Association between Complications and Death within 30 days after General Surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) substudy

Ann Surg. 2024 Jun 11. doi: 10.1097/SLA.0000000000006372. Online ahead of print.

Authors

Lily J Park^{1

2

3}, Flavia K Borges^{1

3

4}, Sandra Ofori^{3

4}, Rahima Nenshi^{1

3}, Michael Jacka⁵, Diane Heels-Ansdell³, Jessica Bogach², Kelly Vogt⁶, Matthew Tv Chan⁷, Anish Verghese⁸, Carisi A Polanczyk⁹, David Skinner¹⁰, J M Asencio¹¹, Pilar Paniagua¹², Michael Rosen¹³, Pablo E Serrano^{2

3}, Michael J Marcaccio², Marko Simunovic^{2

3}, Lehana Thabane^{1

3

14}, P J Devereaux^{1

3

15

16}

Affiliations

¹ Population Health Research Institute, Hamilton, ON, Canada.
² Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Departments of Anesthesiology and Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁶ Department of Surgery, Division of General Surgery, Western University, London Health Sciences Centre, London, ON, Canada.
⁷ The Chinese University of Hong Kong, Central Ave, Hong Kong.
⁸ Department of surgery, CMC Ludhiana, Punjab, India.
⁹ Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
¹⁰ Department of Anaesthesiology and Critical Care, University of Kwa-Zulu Natal, South Africa.
¹¹ Hospital general Universitario Gregorio Marañón, Madrid, Spain.
¹² Department of Anaesthesia and Pain Management Santa Creu i Sant Pau University Hospital, Barcelona, Spain.
¹³ Cleveland Clinic Foundation, Cleveland Ohio, Digestive Disease Institute.
¹⁴ Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹⁵ Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada.
¹⁶ World Health Research, Hamilton, ON, Canada.

PMID: 38860367
DOI: 10.1097/SLA.0000000000006372

Abstract

Objective: To determine the epidemiology of post-operative complications among general surgery patients, inform their relationships with 30-day mortality, and determine the attributable fraction of death of each postoperative complication.

Background: The contemporary causes of post-operative mortality among general surgery patients are not well characterized.

Methods: VISION is a prospective cohort study of adult non-cardiac surgery patients across 28 centres in 14 countries, who were followed for 30 days after surgery. For the subset of general surgery patients, a cox proportional hazards model was used to determine associations between various surgical complications and post-operative mortality. The analyses were adjusted for preoperative and surgical variables. Results were reported in adjusted hazard ratios (HR) with 95% confidence intervals (CI).

Results: Among 7950 patients included in the study, 240 (3.0%) patients died within 30 days of surgery. Five post-operative complications (myocardial injury after non-cardiac surgery [MINS], major bleeding, sepsis, stroke, and acute kidney injury resulting in dialysis) were independently associated with death. Complications associated with the largest attributable fraction (AF) of post-operative mortality (i.e., percentage of deaths in the cohort that can be attributed to each complication, if causality were established) were major bleeding (n=1454, 18.3%, HR 2.49 95%CI 1.87-3.33, P<0.001, AF 21.2%), sepsis (n=783, 9.9%, HR 6.52, 95%CI 4.72-9.01, P<0.001, AF 15.6%), and MINS (n=980, 12.3%, HR 2.00, 95%CI 1.50-2.67, P<0.001, AF 14.4%).

Conclusion: The complications most associated with 30-day mortality following general surgery are major bleeding, sepsis, and MINS. These findings may guide the development of mitigating strategies, including prophylaxis for perioperative bleeding.