| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Departments of *Anesthesia and Perioperative Care, and
Epidemiology and Biostatistics, University of California, San Francisco, California
Address correspondence and reprint requests to Dr. Leung, University of California-San Francisco, Mount Zion Medical Center, Department of Anesthesia and Perioperative Care, 1600 Divisadero St., Rm. C-355, San Francisco, CA 94115. Address e-mail to jmleung{at}itsa.ucsf.edu
To determine the impact of in-hospital postoperative complications on long-term survival, we prospectively studied consecutive patients 
70 yr of age undergoing noncardiac surgery. Potential clinical risk factors were measured and evaluated for their association with the occurrence of long-term postoperative mortality. Long-term survival was determined by using the Kaplan-Meier method. Multivariate correlates of survival were analyzed with the Cox proportional hazards model. The survival of the study group was also compared with the age- and gender-matched general United States population. Five hundred seventeen patients who survived the initial hospitalization were studied. The mean follow-up duration was 28.6 ± 12.8 mo. One hundred sixty-four of 517 patients (31.7%) were deceased at the time of follow-up. A history of cancer (hazard ratio [HR] 2.44, 95% confidence interval [CI] 1.78–3.38, P < 0.0001), ASA physical status >II (HR 2.27, 95% CI 1.61–3.21, P < 0.0001), neurologic disease (HR 1.59, 95% CI 1.13–2.24, P = 0.008), age (HR 1.42 per decade, 95% CI 1.11–1.81, P = 0.005), postoperative pulmonary complications (HR 2.41, 95% CI 1.30–4.48, P = 0.005), and renal complications (HR 6.07, 95% CI 2.23–16.52, P < 0.0001) were significant independent predictors of decreased long-term survival. Compared with the United States population, patients with complications had a greater increase in mortality risk in the first 3 mo after surgery (HR 7.3 versus general population) than those without complications (HR 2.9, P = 0.023). An effort to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.
IMPLICATIONS: Elderly surgical patients who have had an in-hospital postoperative complication have increased mortality, particularly in the first 3 mo after surgery. Efforts to improve perioperative care delivery to elderly surgical patients must include measures to minimize in-hospital postoperative complications, particularly those involving the pulmonary and renal systems.
This article has been cited by other articles:
|
|
 |
|
  J. L. Daban, G. P. De Saint Maurice, E. Batjom, E. Falzone, and S. Ausset Postoperative myocardial damages are a key issue in patients' outcome after hip fracture Age Ageing, July 1, 2009; 38(4): 488 - 489. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Qaseem, V. Snow, N. Fitterman, E. R. Hornbake, V. A. Lawrence, G. W. Smetana, K. Weiss, D. K. Owens, and for the Clinical Efficacy Assessment Subcommittee Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med, April 18, 2006; 144(8): 575 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Smetana, V. A. Lawrence, and J. E. Cornell Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med, April 18, 2006; 144(8): 581 - 595. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Rusca, S. Proietti, P. Schnyder, P. Frascarolo, G. Hedenstierna, D. R. Spahn, and L. Magnusson Prevention of Atelectasis Formation During Induction of General Anesthesia Anesth. Analg., December 1, 2003; 97(6): 1835 - 1839. [Abstract] [Full Text] [PDF]
|
|
|
