When Do Noncardiac Surgery Deaths Occur?

31 Jul When Do Noncardiac Surgery Deaths Occur?

While most people assume that it’s the operating room that is risky for patients undergoing noncardiac surgery a newly released research study says it is during the recovery period. According to the findings of a large international study published in the Canadian Medical Association Journal (CMAJ), only 0.7 percent of the reported deaths in these patients occurred in the operating room while 29 percent of deaths occurred after discharge from hospital.

Most deaths in adults undergoing noncardiac surgery occur not in the operating room, but afterward. Photo Credit: Military Health Systems

The researchers conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. These patients were monitored for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model.

 “Given that most deaths in adults undergoing noncardiac surgery occur not in the operating room, but afterwards, efforts to improve postsurgical care in hospital and at home has substantial potential to reduce mortality,” says author Dr. P.J. Devereaux, McMaster University, Hamilton, Ontario, in a July 29 statement detailing the study’s findings.

Death After Surgery Occurs Globally

According to the researchers, the study, which included 40 004 adults aged 45 years or older in North and South America, Asia, Europe, Africa and Australia who underwent surgery between 2007 and 2013, found that 1.8 percent died within 30 days of noncardiac surgery. Major bleeding, injury to the heart muscle and severe infection (sepsis) accounted for a large portion of deaths (45 percent).

“Approximately 100 million adults aged 45 or older undergo noncardiac surgery worldwide every year, therefore an estimated 1.8 million people die of complications within 30 days,” says Dr. Devereaux. “This means that death after surgery is a major global health burden,” he says.

The researchers call for solutions that focus on prevention, early identification and close management of bleeding, cardiac issues and infection.  These actions may help to reduce these preventable deaths.

Data published are from the Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study funded by more than 70 sources.

Dr. Barnaby Reeves, Bristol Medical School, University of Bristol, Bristol, United Kingdom, in a related commentary, acknowledges the achievement of the study investigators but he cautions policy-makers to heed the inherent biases in such studies when considering the observed relationships between complications and mortality.