For the study, researchers examined outcomes for more than 40,000
patients 45 and older who underwent non-cardiac surgery at 28
hospitals in 14 countries. Researchers monitored patients for
complications and deaths within 30 days of surgery.
Overall, five people, or less than 1% of patients, died in the
operating table, and another 500 patients, or 70%, died in the
hospital. Another 210 deaths, or 29%, didn't happen until after
patients were sent home.
Nearly half of all the deaths were associated with three
complications: major bleeding, heart damage, and bloodstream
"Many families anxiously wait to hear from the surgeon whether their
loved one survived the operation, but our research demonstrates that
very few of the deaths occur in the operating room," said Dr. P.J.
Devereaux, senior author of the study and director of the Division
of Perioperative Care at McMaster University in Canada.
"Our research now demonstrates that there is a need to focus on
postoperative care and transitional care into the home setting to
improve outcomes," Devereaux said by email.
Worldwide, 100 million patients age 45 and older undergo inpatient
surgery unrelated to cardiac issues every year, researchers note in
A wide range of technological and medical advances have made surgery
safer and less invasive in recent years, the study team notes. But
at the same time, patients also are coming to the hospital sicker
and being sent home with complex care needs that once would have
meant a lengthy hospital stay.
In the study, roughly half of the patients had high blood pressure,
one in five had diabetes, and 13% had coronary artery disease.
More than one-third of them came in only for low-risk procedures
that were not emergencies. Many of the rest had major general,
orthopedic, urological, gynecological, vascular or neurological
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Patients who experienced major bleeding after surgery were more than
twice as likely to die within 30 days as people who didn't have this
And patients who developed heart injuries even though they didn't
have heart surgery were also more than twice as likely to die.
Patients who got sepsis, a serious bloodstream infection, were more
than five times more likely to die within 30 days than people who
didn't get these infections.
The study wasn't a controlled experiment designed to identify which
if any complications actually caused any deaths.
Inflammation may be a common denominator in the complications that
were most responsible for deaths, said Barnaby Charles Reeves of the
University of Bristol in the U.K., author of an editorial
accompanying the study.
"Surgery causes a body-wide inflammatory reaction," Reeves said by
email. "This can lead to single or multi-organ failure (kidney,
heart, lungs, sepsis etc.) which leads to death."
Patients may also not recognize that something is wrong when they're
coming off anesthesia or taking narcotic painkillers after surgery,
"This makes patients after surgery vulnerable to delays in
recognizing complications and hence delays in treatment," Devereaux
Surgery also activates patients' inflammatory, stress, and
coagulation systems. The activation of these systems can also
predispose patients to major complications. Patients should advocate
and support research into enhanced monitoring techniques after
surgery, which can help sort out identifying ways to lower the risk
of death after surgery.
SOURCE: http://bit.ly/2LNohts CMAJ, online July 29, 2019.
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