Introduction
Methods
Study sample
Baseline characteristics
Surgical Categories | |
---|---|
Low-risk surgery | |
Breast surgery | |
Hernia surgerya
| |
Minor surgery of soft tissue | |
Minor trauma surgery | |
Perianal surgery | |
Varicose vein surgery | |
Intermediate-risk surgery | |
Appendectomy | |
Carotid artery surgery | |
Cholecystectomy | |
Head and neck surgery | |
Major abdominal surgeryb
| |
Major trauma surgeryc
| |
Thoracic surgery | |
High-risk surgery | |
Ischemic limb amputation | |
Major vascular surgeryd
|
Outcome
Statistical analysis
Results
Patient population
All patients (N = 4479) | Any complication (N = 949) | Overall mortality (N = 730) | |
---|---|---|---|
Demographics | |||
Age, years (mean ± SD) | 55.0 ± 17.5 | 62.7 ± 16.8#
| 71.6 ± 12.3##
|
Male sex (%) | 2307 (51.5 %) | 495 (52.2 %) | 402 (55.1 %)##
|
ASA classification (%) |
#
|
##
| |
I | 1501 (33.5 %) | 157 (16.6 %) | 19 (2.6 %) |
II | 1600 (35.7 %) | 292 (31.0 %) | 149 (20.6 %) |
III | 1169 (26.1 %) | 405 (42.9 %) | 428 (59.0 %) |
IV | 161 (3.6 %) | 85 (9.0 %) | 125 (17.2 %) |
V | 4 (0.1 %) | 4 (0.4 %) | 4 (0.6 %) |
Medical history (%) | |||
Diabetes mellitus | 402 (9.1 %) | 142 (15.1 %)#
| 160 (22.2 %)##
|
Hypertension | 884 (20.0 %) | 261 (27.8 %)#
| 259 (35.9 %)##
|
Cerebrovascular disease | 313 (7.1 %) | 92 (9.8 %)#
| 132 (18.3 %)##
|
Malignant disease | 1028 (23.2 %) | 296 (31.4 %)#
| 358 (49.4 %)##
|
Pathological cardiac history | 825 (18.6 %) | 294 (31.3 %)#
| 358 (49.7 %)##
|
Pathological pulmonary history | 633 (14.3 %) | 186 (19.8 %)#
| 221 (30.7 %)##
|
Smoking* (%) |
#
|
##
| |
Current smoking | 1075 (32.1 %) | 202 (29.2 %) | 183 (32.8 %) |
History | 590 (17.6 %) | 143 (20.7 %) | 157 (28.1 %) |
No smoking | 1682 (50.3 %) | 346 (50.1 %) | 218 (39.1 %) |
BMI category (%) |
#
|
##
| |
Normal weight (BMI 18,5-25 kg/m2) | 1815 (42.3 %) | 339 (37.8 %) | 331 (48.2 %) |
Underweight (BMI < 18,5 kg/m2) | 100 (2.3 %) | 28 (3.1 %) | 35 (5.1 %) |
Overweight (BMI 25-30 kg/m2) | 1635 (38.1 %) | 345 (38.5 %) | 212 (30.9 %) |
Obese (BMI > 30 kg/m2) | 743 (16.6 %) | 185 (20.6 %) | 109 (15.9 %) |
Surgical categories (%) |
#
|
##
| |
Low-risk surgery | 2527 (56.4 %) | 302 (31.8 %) | 238 (32.6 %) |
Breast | 382 (8.5 %) | 49 (5.2 %) | 63 (8.6 %) |
Hernia | 839 (18.7 %) | 88 (9.3 %) | 79 (10.8 %) |
Minor surgery of soft tissue | 408 (9.1 %) | 66 (7.0 %) | 58 (7.9 %) |
Minor trauma | 228 (5.1 %) | 27 (2.8 %) | 12 (1.6 %) |
Perianal surgery | 278 (6.2 %) | 19 (2.0 %) | 14 (1.9 %) |
Varicose vein surgery | 392 (8.8 %) | 53 (5.6 %) | 12 (1.6 %) |
Intermediate-risk surgery | 1720 (38.4 %) | 534 (56.3 %) | 367 (50.3 %) |
Appendectomy | 251 (5.6 %) | 55 (5.8 %) | 11 (1.5 %) |
Carotid artery | 74 (1.7 %) | 12 (1.3 %) | 15 (2.1 %) |
Cholecystectomy | 495 (11.1 %) | 100 (10.5 %) | 30 (4.1 %) |
Head and neck | 102 (2.3 %) | 30 (3.2 %) | 8 (1.1 %) |
Major abdominal | 629 (14.0 %) | 295 (31.1 %) | 222 (30.4 %) |
Major trauma | 79 (1.8 %) | 27 (2.8 %) | 46 (6.3 %) |
Thoracic | 90 (2.0 %) | 15 (1.6 %) | 35 (4.8 %) |
High risk surgery | 232 (5.2 %) | 113 (11.9 %) | 125 (17.1 %) |
Amputation | 36 (0.8 %) | 18 (1.9 %) | 29 (4.0 %) |
Major vascular | 196 (4.4 %) | 95 (10.0 %) | 96 (13.2 %) |
Surgery characteristics (%) | |||
General anaesthesia | 3824 (85.6 %) | 866 (91.7 %)#
| 654 (90.0 %)##
|
Outpatient surgery | 1539 (34.4 %) | 139 (14.6 %)#
| 67 (9.2 %)##
|
Length of stay, (days) (median + IQR) | 2 (1–8) | 8 (2–16) | 7 (2–15) |
Blood Loss, (mL) (median + IQR) | 15 (5–50) | 50 (20–250) | 50 (10–200) |
Operation time, (min) (median + IQR) | 41 (25–68) | 63 (38–110) | 61 (35–113) |
Male (%) | Age, years Mean ± SD | HT (%) | DM (%) | Cerebrovascular disease (%) | Malignant disease (%) | Pathological cardiac history (%) | Pathological pulmonary history (%) | Current smoking (%) | |
---|---|---|---|---|---|---|---|---|---|
Low surgical risk | 1408 (55.7 %) | 52.2 (± 16.4) | 380 (15.2 %) | 152 (6.1 %) | 94 (3.8 %) | 511 (20.5 %) | 339 (13.6 %) | 287 (11.5 %) | 604 (32.6 %) |
Breast | 19 (5.0 %) | 57.3 (± 14.8) | 80 (20.9 %) | 33 (8.6 %) | 14 (3.7 %) | 333 (87.2 %) | 52 (13.6 %) | 41 (10.7 %) | 91 (28.2 %) |
Hernia | 739 (88.1 %) | 56.5 (± 15.6) | 126 (15.1 %) | 47 (5.6 %) | 45 (5.4 %) | 48 (5.8 %) | 152 (18.2 %) | 96 (11.5 %) | 194 (30.1 %) |
Minor surgery of soft tissue | 226 (55.4 %) | 49.8 (± 16.5) | 77 (18.9 %) | 37 (9.1 %) | 17 (4.2 %) | 97 (23.8 %) | 59 (14.5 %) | 66 (16.2 %) | 102 (34.8 %) |
Minor trauma | 102 (44.7 %) | 48.3 (± 18.5) | 34 (16.3 %) | 13 (6.2 %) | 7 (3.3 %) | 7 (3.3 %) | 21 (10.0 %) | 20 (9.6 %) | 45 (32.8 %) |
Perianal surgery | 207 (74.5 %) | 40.5 (± 15.7) | 21 (7.8 %) | 14 (5.2 %) | 5 (1.9 %) | 9 (3.3 %) | 28 (10.4 %) | 21 (7.8 %) | 98 (50.0 %) |
Varicose vein surgery | 115 (29.3 %) | 50.9 (± 13.0) | 42 (10.7 %) | 8 (2.0 %) | 6 (1.5 %) | 17 (4.3 %) | 27 (6.9 %) | 43 (11.0 %) | 74 (28.6 %) |
Intermediate surgical risk | 739 (43.0 %) | 57.0 (± 18.4) | 394 (23.1 %) | 181 (10.6 %) | 174 (10.2 %) | 489 (28.6 %) | 347 (20.3 %) | 288 (16.9 %) | 388 (29.6 %) |
Appendectomy | 126 (50.2 %) | 39.6 (± 17.9) | 24 (9.7 %) | 8 (3.2 %) | 4 (1.6 %) | 12 (4.9 %) | 14 (5.7 %) | 8 (3.2 %) | 51 (27.7 %) |
Carotid artery | 53 (71.6 %) | 67.4 (± 9.3) | 31 (41.9 %) | 18 (24.3 %) | 60 (81.1 %) | 7 (9.5 %) | 32 (43.2 %) | 10 (13.5 %) | 28 (41.2 %) |
Cholecystectomy | 152 (30.7 %) | 54.0 (± 15.2) | 97 (19.6 %) | 38 (7.7 %) | 24 (4.9 %) | 36 (7.3 %) | 74 (15.0 %) | 48 (9.7 %) | 123 (31.9 %) |
Head and neck | 41 (40.2 %) | 54.1 (± 15.0) | 20 (19.8 %) | 9 (8.9 %) | 4 (4.0 %) | 22 (21.8 %) | 7 (6.9 %) | 8 (7.8 %) | 23 (34.3 %) |
Major abdominal | 292 (46.4 %) | 62.8 (± 16.7) | 175 (28.0 %) | 84 (13.4 %) | 59 (9.4 %) | 340 (54.2 %) | 154 (24.6 %) | 110 (17.6 %) | 122 (25.8 %) |
Major trauma | 22 (27.8 %) | 76.1 (± 17.2) | 27 (35.5 %) | 19 (25.0 %) | 14 (18.4 %) | 16 (20.8 %) | 38 (50.0 %) | 23 (30.3) | 9 (18.0 %) |
Thoracic | 53 (58.9 %) | 60.0 (± 15.7) | 20 (22.2 %) | 5 (5.6 %) | 9 (10.0 %) | 56 (62.2 %) | 28 (31.1 %) | 81 (90.0 %) | 32 (38.1 %) |
High surgical risk | 160 (69.0 %) | 69.7 (± 11.5) | 110 (47.8 %) | 69 (30.0 %) | 45 (19.6 %) | 28 (12.2 %) | 139 (60.4 %) | 58 (25.2 %) | 83 (45.4 %) |
Amputation | 18 (50.0 %) | 68.8 (± 15.2) | 16 (44.4 %) | 19 (52.8 %) | 13 (36.1 %) | 4 (11.1 %) | 21 (58.3 %) | 9 (25.0 %) | 11 (40.7 %) |
Major vascular | 142 (72.4 %) | 69.8 (± 10.7) | 94 (48.5 %) | 50 (25.8 %) | 32 (16.5 %) | 24 (12.4 %) | 118 (60.8 %) | 49 (25.3 %) | 72 (46.2 %) |
Postoperative complications
No complication (%) | Self-limiting complication (Grade 1) (%) | Non-self-limiting complication (Grade 2 + 3) (%) | Major complication (Grade 4) (%) | Death (Grade 5) (%) | |
---|---|---|---|---|---|
Low-risk surgery | 2225 (88.0) | 77 (3.0) | 216 (8.5) | 1 (0.0) | 8 (0.3) |
Breast | 333 (87.2) | 13 (3.4) | 36 (9.4) | 0 (0.0) | 0 (0.0) |
Hernia | 751 (89.5) | 19 (2.3) | 65 (7.7) | 1 (0.1) | 3 (0.4) |
Minor surgery of soft tissue | 342 (83.8) | 18 (4.4) | 44 (10.8) | 0 (0.0) | 4 (1.0) |
Minor trauma | 201 (88.2) | 8 (3.5) | 19 (8.3) | 0 (0.0) | 0 (0.0) |
Perianal surgery | 259 (93.2) | 5 (1.8) | 13 (4.7) | 0 (0.0) | 1 (0.4) |
Varicose vein surgery | 339 (86.5) | 14 (3.6) | 39 (9.9) | 0 (0.0) | 0 (0.0) |
Intermediate-risk surgery | 1186 (69.0) | 99 (5.8) | 349 (20.3) | 39 (2.3) | 47 (2.7) |
Appendectomy | 196 (78.1) | 16 (6.4) | 37 (14.7) | 1 (0.4) | 1 (0.4) |
Carotid artery | 62 (83.8) | 5 (6.8) | 2 (2.7) | 3 (4.1) | 2 (2.7) |
Cholecystectomy | 395 (79.8) | 30 (6.1) | 64 (12.9) | 3 (0.6) | 3 (0.6) |
Head and neck | 72 (70.6) | 11 (10.8) | 19 (18.6) | 0 (0.0) | 0 (0.0) |
Major abdominal | 334 (53.1) | 31 (4.9) | 198 (31.5) | 29 (4.6) | 37 (5.9) |
Major trauma | 52 (65.8) | 2 (2.5) | 19 (24.1) | 3 (3.8) | 3 (3.8) |
Thoracic | 75 (83.3) | 4 (4.4) | 10 (11.1) | 0 (0.0) | 1 (1.0) |
High risk surgery | 119 (51.3) | 6 (2.6) | 76 (32.8) | 11 (4.7) | 20 (8.6) |
Amputation | 18 (50.0) | 2 (5.6) | 9 (25.0) | 1 (2.8) | 6 (16.7) |
Major vascular | 101 (51.5) | 4 (2.0) | 67 (34.2) | 10 (5.1) | 14 (7.1) |
All types | 3530 (78.8) | 182 (4.1) | 641 (14.3) | 51 (1.1) | 75 (1.7) |
All-cause mortality
Events | Univariate | Multivariable* | |||
---|---|---|---|---|---|
N (%) | Hazard Ratio | 95 % CI | Hazard Ratio | 95 % CI | |
Overall mortality | |||||
Low-risk surgery | 238 | 1 | – | 1 | – |
Intermediate-risk surgery | 367 | 2.364 | 1.998–2.796 | 1.216 | 1.017–1.455 |
High-risk surgery | 125 | 7.512 | 6.014–9.382 | 1.507 | 1.166–1.946 |
Cardiovascular mortality | |||||
Low-risk surgery | 57 | 1 | – | 1 | – |
Intermediate-risk surgery | 58 | 1.686 | 1.170–2.431 | 0.860 | 0.574–1.287 |
High-risk surgery | 46 | 12.747 | 8.621–18.848 | 1.923 | 1.194–3.095 |
Cancer-related mortality | |||||
Low-risk surgery | 93 | 1 | – | 1 | – |
Intermediate-risk surgery | 192 | 3.301 | 2.574–4.233 | 1.503 | 1.143–1.977 |
High-risk surgery | 21 | 3.615 | 2.270–5.758 | 1.281 | 0.762–2.152 |
Late causes of death
Association between postoperative complications and mortality
Events | Univariate | Multivariable | |||
---|---|---|---|---|---|
N (%) | Hazard Ratio | 95 % CI | Hazard Ratio | 95 % CI | |
Overall mortality | 627 | 2.393 | 2.033–2.818 | 1.197 | 1.009–1.421 |
Cardiovascular mortality | 140 | 3.527 | 2.526–4.924 | 1.890 | 1.312–2.721 |
Cancer-related mortality | 291 | 2.230 | 1.748–2.845 | 1.101 | 0.850–1.426 |