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Observational Study
. 2021 Nov 6;21(1):393.
doi: 10.1186/s12893-021-01392-z.

Postoperative complications: an observational study of trends in the United States from 2012 to 2018

Emilie Even Dencker  1   2 , Alexander Bonde  1   2 , Anders Troelsen  3   4 , Kartik Mangudi Varadarajan  5 , Martin Sillesen  6   7   8
Affiliations
Observational Study

Postoperative complications: an observational study of trends in the United States from 2012 to 2018

Emilie Even Dencker et al. BMC Surg. .

Abstract

Background: Postoperative complications continue to constitute a major issue for both the healthcare system and the individual patient and are associated with inferior outcomes and higher healthcare costs. The objective of this study was to evaluate the trends of postoperative complication rates over a 7-year period.

Methods: The NSQIP datasets from 2012 to 2018 were used to assess 30-day complication incidence rates including mortality rate following surgical procedures within ten surgical subspecialties. Multivariable logistic regression was used to associate complication rates with dataset year, while adjusting for relevant confounders.

Results: A total of 5,880,829 patients undergoing major surgery were included. Particularly the incidence rates of four complications were found to be decreasing: superficial SSI (1.9 to 1.3%), deep SSI (0.6 to 0.4%), urinary tract infection (1.6 to 1.2%) and patient unplanned return to the operating room (3.1 to 2.7%). Incidence rate for organ/space SSI exhibited an increase (1.1 to 1.5%). When adjusted, regression analyses indicated decreased odds ratios (OR) through the study period years for particularly deep SSI OR 0.92 [0.92-0.93], superficial SSI OR 0.94 [0.94-0.94] and acute renal failure OR 0.96 [0.95-0.96] as the predictor variable (study year) increased (p < 0.01). However, OR's for organ/space SSI 1.05 [1.05-1.06], myocardial infarction 1.01 [1.01-1.02] and sepsis 1.01 [1.01-1.02] increased slightly over time (all p < 0.01).

Conclusions: Incidence rates for the complications exhibited a stable trend over the study period, with minor in or decreases observed.

Keywords: Complications; Surgery; Trends.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient cases from American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) included in the study. All cases with available information on sex, age and surgical subspecialty were included
Fig. 2
Fig. 2
Incidence rates (%) over the study period for the 14 studied postoperative complications for all surgical procedures combined. SSI surgical site infection; DVT deep venous thrombosis, CVA cerebrovascular accident, OR operating room
Fig. 3
Fig. 3
Postoperative complication incidence rates from 2012 to 2018 for orthopedic (top) and general (bottom) surgery. SSI: Surgical Site Infection; DVT: Deep Venous Thrombosis; CVA: Cerebrovascular Accident: OR: Operating Room
See this image and copyright information in PMC

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