One-year Outcomes after Discharge from Noncardiac Surgery and Association between Predischarge Complications and Death after Discharge: Analysis of the VISION Prospective Cohort Study
Authors: Roshanov Pavel S. , Chan Matthew T. V. , Borges Flavia K. , Conen David , Wang C. Y. , Xavier Denis , Berwanger Otavio , Marcucci Maura , Sessler Daniel I. , Szczeklik Wojciech , Spence Jessica , Alonso-Coello Pablo , Fernández Carmen , Pearse Rupert M. , Malaga German , Garg Amit X. , Srinathan Sadeesh K. , Jacka Michael J. , Tandon Vikas , McGillion Michael , Popova Ekaterine , Sigamani Alben , Abraham Valsa , Biccard Bruce M. , Villar Juan Carlos , Chow Clara K. , Polanczyk Carísi A. , Tiboni Maria , Whitlock Richard , Ackland Gareth L. , Panju Mohamed , Lamy André , Sapsford Robert , Williams Colin , Wu William Ka Kei , Cortés Olga L. , MacNeil S. Danielle , Patel Ameen , Belley-Côté Emilie P. , Ofori Sandra , McIntyre William F. , Leong Darryl P. , Heels-Ansdell Diane , Gregus Krysten , Devereaux P. J. 
Published: September 2023

Background

In previous analyses, myocardial injury after noncardiac surgery, major bleeding, and sepsis were independently associated with most deaths in the 30 days after noncardiac surgery, but most of these deaths occurred during the index hospitalization for surgery. The authors set out to describe outcomes after discharge from hospital up to 1 yr after inpatient noncardiac surgery and associations between predischarge complications and postdischarge death up to 1 yr after surgery.

Methods

This study was an analysis of patients discharged after inpatient noncardiac surgery in a large international prospective cohort study across 28 centers from 2007 to 2013 of patients aged 45 yr or older followed to 1 yr after surgery. The study estimated (1) the cumulative postdischarge incidence of death and other outcomes up to a year after surgery and (2) the adjusted time-varying associations between postdischarge death and predischarge complications including myocardial injury after noncardiac surgery, major bleeding, sepsis, infection without sepsis, stroke, congestive heart failure, clinically important atrial fibrillation or flutter, amputation, venous thromboembolism, and acute kidney injury managed with dialysis.

Results

Among 38,898 patients discharged after surgery, the cumulative 1-yr incidence was 5.8% (95% CI, 5.5 to 6.0%) for all-cause death and 24.7% (95% CI, 24.2 to 25.1%) for all-cause hospital readmission. Predischarge complications were associated with 33.7% (95% CI, 27.2 to 40.2%) of deaths up to 30 days after discharge and 15.0% (95% CI, 12.0 to 17.9%) up to 1 yr. Most of the association with death was due to myocardial injury after noncardiac surgery (15.6% [95% CI, 9.3 to 21.9%] of deaths within 30 days, 6.4% [95% CI, 4.1 to 8.7%] within 1 yr), major bleeding (15.0% [95% CI, 8.3 to 21.7%] within 30 days, 4.7% [95% CI, 2.2 to 7.2%] within 1 yr), and sepsis (5.4% [95% CI, 2.2 to 8.6%] within 30 days, 2.1% [95% CI, 1.0 to 3.1%] within 1 yr).

Conclusions

One in 18 patients 45 yr old or older discharged after inpatient noncardiac surgery died within 1 yr, and one quarter were readmitted to the hospital. The risk of death associated with predischarge perioperative complications persists for weeks to months after discharge.

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