Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.

Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

orldwide, 100 million patients aged 45 years and older undergo inpatient noncardiac surgery each year. 1,2 Although surgery has the potential to improve and prolong quality and duration of life, it is also associated with complications and mortality. During the last several decades, advances in perioperative care have included less invasive surgery, improved anesthetic techniques, enhanced intraoperative monitoring and more rapid mobilization after surgery. 2 At the same time, the age and the number of comorbidities of patients undergoing surgery have increased substantially. 3,4 Hence, in the current context, the frequency and timing of mortality is uncertain, as is the relation between perioperative complications to mortality. In a large prospective study (The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation [VISION] Study), we systematically followed patients who underwent noncardiac surgery and documented perioperative complications and death. Our a priori objectives included establishing the frequency and timing of death after noncardiac surgery, and the association between perioperative complications and postsurgical death. Methods Study design, population and data We previously reported details of the study design and methods. 5,6 VISION was an international, prospective cohort study. Patients were included if they were aged 45 years or older, had undergone noncardiac surgery, had received general or regional anesthesia and remained in hospital for at least 1 night after surgery. Patients were recruited at 28 centres in 14 countries in

Background: The association of patient expectations about recovery with the development of chronic post-surgical pain (CPSP) is uncertain. Methods: Three hundred and fifty-nine patients enrolled in the SPRINT trial completed the Somatic Preoccupation and Coping (SPOC) questionnaire six weeks after a traumatic tibial fracture repair. The SPOC questionnaire measures patients' somatic complaints, coping, and optimism for recovery. Using adjusted models, we explored the association of SPOC scores with ≥ mild CPSP and ≥ moderate pain interference with activity at one yr after surgery. Results: Of 267 tibial fracture patients with data available for analysis, 147 (55.1%) reported CPSP at one yr. The incidence of CPSP was 37.6% among those with low (≤40) SPOC scores, 54.1% among those with intermediate (41-80) scores, and 81.7% among those with high (>80) scores. Addition of SPOC scores to an adjusted regression model to predict CPSP improved the c-statistic from 0.61 (95% CI 0.55-0.68) to 0.70 (95% CI 0.64-0.76, P=0.005 for the difference) and found the greatest risk was associated with high SPOC scores (OR 6.56,. Similarly, an adjusted regression model to predict pain interference with function at one yr (c-statistic 0.77, 95% CI 0.71-0.83) found the greatest risk for those with high SPOC scores (OR 10.10,. Conclusions: Patient's coping and expectations of recovery, as measured by the SPOC questionnaire, is an independent predictor of CPSP and pain interference one yr after traumatic tibial fracture. Future studies should explore whether these beliefs can be modified, and if doing so improves prognosis. Clinical trial registration: NCT 00038129