Postoperative Complications Affect Long-Term Survival

A new study suggests that postoperative in-hospital morbidity not only present a risk to patients in the short term, but may also reduce long-term survival.

Researchers at Imperial College London (United Kingdom) and the University of Pennsylvania (Philadelphia, USA) searched MEDLINE, Web of Science, and reference lists of articles for studies assessing postoperative in-hospital complications and morbidity. Procedure-specific or technical failure-related complications were excluded, as were studies of poor methodological quality. In all, 18 eligible studies involving 134,785 patients with an overall complication rate of 22.6% were included. The studies included operations for both benign and malignant disease.

Meta-analysis demonstrated reduced overall survival after any postoperative complication for ten studies with eligible data (20,755 patients), with a hazard ratio (HR) of 1.28; overall survival following infectious complications showed a HR of 1.92. In analyses of disease-free survival, the HR was 1.26 for all postoperative complications and 1.55 for infectious complications. Inclusion of poor-quality studies in a sensitivity analysis had no effect on the overall results. The study was published on August 29, 2014, in the British Journal of Surgery.

“Postoperative complications have a negative effect on long-term survival; this relationship appears to be stronger for infectious complications,” concluded lead author Philip Pucher, MRCS, and colleagues of the department of surgery and cancer. “The preventable nature of these complications suggests more must be done to improve care and thus enhance survival rates following major surgery.”

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Imperial College London
University of Pennsylvania