Association between Complications and Death Within 30 days after General Surgery

OBJECTIVE: To determine the epidemiology of postoperative 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 postoperative mortality among general surgery patients are not well characterized. METHODS: VISION is a prospective cohort study of adult non-cardiac surgery patients across 28 centers 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 postoperative 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 postoperative 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 postoperative mortality (ie, 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, 9.8%, 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%). CONCLUSIONS: 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.