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Observational Study
. 2016 May;20(5):1034-41.
doi: 10.1007/s11605-016-3084-4. Epub 2016 Feb 8.

Long-Term Survival After Complications Following Major Abdominal Surgery

Jennifer Straatman  1 , Miguel A Cuesta  2 , Elly S M de Lange-de Klerk  3 , Donald L van der Peet  2
Affiliations
Observational Study

Long-Term Survival After Complications Following Major Abdominal Surgery

Jennifer Straatman et al. J Gastrointest Surg. 2016 May.

Abstract

Introduction: Postoperative complications have been associated with decreased long-term survival in cardiac, orthopedic, and vascular surgery. For major abdominal surgery research, conflicting evidence is reported in smaller studies. The aim of this study was to assess the effect of complications on long-term survival in major abdominal surgery.

Material and methods: An observational cohort study was conducted of 861 consecutive patients that underwent major abdominal surgery between January 2009 and March 2014, with prospective assessment of the survival status. The effect of postoperative complications on survival was assessed.

Results: Postoperative complications were associated with decreased survival, even after applying correction for 30-day mortality (p < 0.001). Stratified Cox regression analysis depicted postoperative complications to be an important predictor for survival in upper gastrointestinal and female hepatopancreaticobiliary patients. Correction was applied for age, gender, BMI, ASA classification, radicality, and positive lymph node status.

Conclusion: These results further indicate the importance of prevention and early diagnosis and treatment of complications. Etiological factors are believed to be both sustained levels of inflammatory markers, as well as attenuated immune response in malignancy with subsequent cancer cell seeding. Future research should aim to prevent and early diagnose postoperative complications to prevent morbidity and mortality not only in the early postoperative phase, but also in the long term.

Keywords: Major abdominal surgery; Postoperative complications; Survival.

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Figures

Fig. 1
Fig. 1
a Kaplan-Meier curve stratified for patients with no, minor or major complications. b Kaplan-Meier curve excluding patients with less than 30-day follow-up. Arrow indicates differences in curve for major complications
Fig. 2
Fig. 2
Stratified analysis of survival in uncomplicated and complicated cases in upper GI, HPB, and colorectal surgery. p Values depicted for log-rank test in each group
See this image and copyright information in PMC

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