Association between Complications and Death Within 30 days after General Surgery: A Vascular Event in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Lily J Park^{1

2

3}, Flavia K Borges^{1

3

4}, Sandra Ofori^{1

3

4}, Rahima Nenshi^{1

2}, Michael Jacka⁵, Diane Heels-Ansdell³, Jessica Bogach², Kelly Vogt⁶, Matthew Tv Chan⁷, Anish Verghese⁸, Carisi A Polanczyk⁹, David Skinner¹⁰, J M Asencio¹¹, Pilar Paniagua¹², Michael Rosen¹³, Pablo E Serrano^{2

3}, Michael J Marcaccio², Marko Simunovic^{2

3}, Lehana Thabane^{1

3

14}, P J Devereaux^{1

3

15

16}

Affiliations

¹ Population Health Research Institute, Hamilton, ON, Canada.
² Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Departments of Anesthesiology and Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁶ Department of Surgery, Division of General Surgery, Western University, London Health Sciences Centre, London, ON, Canada.
⁷ The Chinese University of Hong Kong, Central Ave, Hong Kong.
⁸ Department of surgery, CMC Ludhiana, Punjab, India.
⁹ Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
¹⁰ Department of Anaesthesiology and Critical Care, University of Kwa-Zulu Natal, South Africa.
¹¹ Hospital general Universitario Gregorio Marañón, Madrid, Spain.
¹² Department of Anaesthesia and Pain Management Santa Creu i Sant Pau University Hospital, Barcelona, Spain.
¹³ Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH.
¹⁴ Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹⁵ Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada.
¹⁶ World Health Research, Hamilton, ON, Canada.

PMID: 38860367
DOI: 10.1097/SLA.0000000000006372

Multicenter Study

Association between Complications and Death Within 30 days after General Surgery: A Vascular Event in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Lily J Park et al. Ann Surg. 2025.

. 2025 Dec 1;282(6):1007-1013.

doi: 10.1097/SLA.0000000000006372. Epub 2024 Jun 11.

Authors

Affiliations

¹ Population Health Research Institute, Hamilton, ON, Canada.
² Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada.
³ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Departments of Anesthesiology and Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
⁶ Department of Surgery, Division of General Surgery, Western University, London Health Sciences Centre, London, ON, Canada.
⁷ The Chinese University of Hong Kong, Central Ave, Hong Kong.
⁸ Department of surgery, CMC Ludhiana, Punjab, India.
⁹ Universidade Federal de Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
¹⁰ Department of Anaesthesiology and Critical Care, University of Kwa-Zulu Natal, South Africa.
¹¹ Hospital general Universitario Gregorio Marañón, Madrid, Spain.
¹² Department of Anaesthesia and Pain Management Santa Creu i Sant Pau University Hospital, Barcelona, Spain.
¹³ Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland OH.
¹⁴ Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹⁵ Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada.
¹⁶ World Health Research, Hamilton, ON, Canada.

PMID: 38860367
DOI: 10.1097/SLA.0000000000006372

Abstract

Objective: To determine the epidemiology of postoperative complications among general surgery patients, inform their relationships with 30-day mortality, and determine the attributable fraction of death of each postoperative complication.

Background: The contemporary causes of postoperative mortality among general surgery patients are not well characterized.

Methods: VISION is a prospective cohort study of adult non-cardiac surgery patients across 28 centers in 14 countries who were followed for 30 days after surgery. For the subset of general surgery patients, a Cox proportional hazards model was used to determine associations between various surgical complications and postoperative mortality. The analyses were adjusted for preoperative and surgical variables. Results were reported in adjusted hazard ratios (HR) with 95% confidence intervals (CI).

Results: Among 7950 patients included in the study, 240 (3.0%) patients died within 30 days of surgery. Five postoperative complications [myocardial injury after non-cardiac surgery (MINS), major bleeding, sepsis, stroke, and acute kidney injury resulting in dialysis] were independently associated with death. Complications associated with the largest attributable fraction (AF) of postoperative mortality (ie, percentage of deaths in the cohort that can be attributed to each complication, if causality were established) were major bleeding (n=1454, 18.3%, HR 2.49 95% CI: 1.87-3.33, P <0.001, AF 21.2%), sepsis (n=783, 9.8%, HR 6.52, 95% CI: 4.72-9.01, P <0.001, AF 15.6%), and MINS (n=980, 12.3%, HR 2.00, 95% CI: 1.50-2.67, P <0.001, AF 14.4%).

Conclusions: The complications most associated with 30-day mortality following general surgery are major bleeding, sepsis, and MINS. These findings may guide the development of mitigating strategies, including prophylaxis for perioperative bleeding.

Keywords: general surgery; mortality; perioperative care; surgical complications.

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Conflict of interest statement

Based on study questions P.J.D. has originated and grants he has written, he has received grants from Abbott Diagnostics, AOP Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, CloudDX, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, Siemens and Stryker. Dr. Devereaux has participated in advisory board meetings for GlaxoSmithKline, Boehringer Ingelheim, Bayer, and Quidel Canada. He attended an expert panel meeting with AstraZeneca and Boehringer Ingelheim, and he was a Consultant for a call with Roche Pharma and consultant work with Abbott Diagnostics, Astra Zeneca, Renibus, Roche Canada, and Trimedic. He has also been invited as a speaker with Bayer Inc, Novartis Pharma Canada, and Abbott Diagnostics. F.K.B. received investigator-initiated research grants from Roche Diagnostics and SIEMENS. P.E.S. reports personnel fees from Incyte Biosciences Canada for consulting services. M.R. has no conflicts of interest relevant to this work but discloses the following: ACHQC Medical Director, Telabio grant support, and Ariste Medical Stock options. The remaining authors declare no conflicts of interest.

References

1. General Surgery | Global Trends & Opportunities 2018 - Life Science Intelligence. Accessed December 21, 2023. https://www.lifesciencemarketresearch.com/market-reports/general-surgery...
1. Mullen MG, Michaels AD, Mehaffey JH, et al. Risk associated with complications and mortality after urgent surgery vs elective and emergency surgery: Implications for defining “quality” and reporting outcomes for urgent surgery. JAMA Surgery. 2017;152:768–774.
1. Nepogodiev D, Martin J, Biccard B, et al. Global burden of postoperative death. National Institute for Health Resarch. 2019;393:401.
1. Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery. Ann Intern Med. 2001;134:637–643.
1. Inokuchi M, Kato K, Sugita H, et al. Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer. BMC Surg. 2014;14:97.

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Association between Complications and Death Within 30 days after General Surgery: A Vascular Event in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Affiliations

Association between Complications and Death Within 30 days after General Surgery: A Vascular Event in Noncardiac Surgery Patients Cohort Evaluation (VISION) Substudy

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical