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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Anesthetic Management and One-Year Mortality After Noncardiac Surgery

Terri G. Monk, MD, MS^*, Vikas Saini, MD, FACC, B. Craig Weldon, MD^*, and Jeffrey C. Sigl, PhD

*Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, The Cardiovascular Specialists LLC, Hyannis, Massachusetts, Aspect Medical Systems, Newton, Massachusetts

Address correspondence and reprint requests to Terri Monk, MD, MS, Anesthesiology Service (112C), VAMC, 508 Fulton Street, Durham, NC 27705. Address e-mail to terri.monk{at}duke.edu

Little is known about the effect of anesthetic management on long-term outcomes. We designed a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia to determine if mortality in the first year after surgery is associated with demographic, preoperative clinical, surgical, or intraoperative variables. One-year mortality was 5.5% in all patients (n = 1064) and 10.3% in patients 65 yr old (n = 243). Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P < 0.0001), cumulative deep hypnotic time (Bispectral Index® <45) (relative risk = 1.244/h; P = 0.0121) and intraoperative systolic hypotension (relative risk = 1.036/min; P = 0.0125). Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated.

IMPLICATIONS: A prospective, longitudinal study of 1-yr postoperative mortality after noncardiac surgery confirms that comorbidity is the primary predictor and that intraoperative hypotension and prolonged cumulative deep hypnotic time are also significant risk factors. Intraoperative anesthetic management may have a greater effect on long-term outcomes than previously appreciated.

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