Association between complications and death within 30 days after noncardiac surgery

Spence, Jessica; LeManach, Yannick; Chan, Matthew T. V.; Wang, C.Y.; Sigamani, Alben; Xavier, Denis; Pearse, Rupert M; Alonso‐Coello, Pablo; Garutti, Ignacio; Srinathan, Sadeesh; Duceppe, Emmanuelle; Walsh, Michael; Borges, Flávia Kessler; Málaga, Germán; Abraham, Valsa; Faruqui, Atiya; Berwanger, Otávio; Biccard, Bruce; Villar, Juan Carlos; Sessler, Daniel I.; Kurz, Andrea; Chow, Clara K; Polanczyk, Carísi Anne; Szczeklik, Wojciech; Ackland, Gareth L.; X., Garg Amit; Jacka, Michael J.; Guyatt, Gordon; Sapsford, Robert J; Williams, Colin; Cortés, Olga; Coriat, Pierre; Patel, Ameen; Tiboni, Maria; Belley‐Côté, Emilie P.; Yang, Stephen Su; Heels‐Ansdell, Diane; McGillion, Michael; Schünemann, Holger J.; Parlow, Simon; Patel, Matthew; Pettit, Shirley; Yusuf, Salim; Devereaux, P.J.

doi:10.1503/cmaj.190221

Cited by 210 publications

(131 citation statements)

References 24 publications

(13 reference statements)

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“…Such observation could also be explained by false negative COVID-19 results in suspected patients, potentially aligning their outcome to those of COVID-19 patients [ 25 ]. Overall, like other groups, we observed a moderately high 30-day postoperative mortality that was higher than expected in non-cardiac surgery (1–4%) [ 26 , 27 ].…”

Section: Discussionsupporting

confidence: 78%

Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study

Carrier

Amzallag²,

Lecluyse

et al. 2021

BMC Anesthesiol

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Background Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who underwent a surgery and the pandemic impact on surgical activities. Methods We conducted a multicenter cohort study between March 13 and June 192,020. We included all COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included concomitant suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and postoperative mortality. Our primary outcome was 30-day mortality. We also collected data on overall surgical activities during this first wave and during the same period in 2019. Results We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was high (15.9%). This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22,616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44,486 cases). Conclusion In this Canadian cohort study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was high (15.9%). Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. Trial registration ClinicalTrials.gov Identifier: NCT04458337.

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Section: Discussionsupporting

confidence: 78%

Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study

Carrier

Amzallag²,

Lecluyse

et al. 2021

BMC Anesthesiol

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“…The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study found that 0.7% of deaths of adult patients who underwent non-cardiac surgery occurred in the operating room and 99.3% occurred after the procedure, with 29% occurring after discharge from hospital. The findings were reported in the Canadian Medical Association Journal 1…”

supporting

confidence: 52%

Most deaths related to non-cardiac surgery occur outside operating room, finds study

Kermode-Scott¹

2019

BMJ

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“…In low-care settings, such as surgical wards, the current standard is intermittent measurement of vital signs only, usually once every shift [ 1 , 2 ]. By contrast, when patients are discharged after major surgery, vital signs are no longer monitored at all, while it is known that more than 29% of deaths after noncardiac surgery occur after patients are discharged from the hospital [ 3 ]. Although the risk of patient deterioration has decreased by the time the patient is discharged from hospital, the risk that patient deterioration will go unnoticed increases.…”

Section: Introductionmentioning

confidence: 99%

Wireless Remote Home Monitoring of Vital Signs in Patients Discharged Early After Esophagectomy: Observational Feasibility Study

Breteler¹,

Numan²,

Ruurda³

et al. 2020

JMIR Perioper Med

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Background Hospital stays after major surgery are shorter than ever before. Although enhanced recovery and early discharge have many benefits, some complications will now first manifest themselves in home settings. Remote patient monitoring with wearable sensors in the first days after hospital discharge may capture clinical deterioration earlier but is largely uncharted territory. Objective This study aimed to assess the technical feasibility of patients, discharged after esophagectomy, being remotely monitored at home with a wireless patch sensor and the experiences of these patients. In addition, we determined whether observing vital signs with a wireless patch sensor influences clinical decision making. Methods In an observational feasibility study, vital signs of patients were monitored with a wearable patch sensor (VitalPatch, VitalConnect Inc) during the first 7 days at home after esophagectomy and discharge from hospital. Vital signs trends were shared with the surgical team once a day, and they were asked to check the patient’s condition by phone each morning. Patient experiences were evaluated with a questionnaire, and technical feasibility was analyzed on a daily basis as the percentage of data loss and gap durations. In addition, the number of patients for whom a change in clinical decision was made based on the results of remote vital signs monitoring at home was assessed. Results Patients (N=20) completed 7 days each of home monitoring with the wearable patch sensor. Each of the patients had good recovery at home, and remotely observed vital signs trends did not alter clinical decision making. Patients appreciated that surgeons checked their vital signs daily (mean 4.4/5) and were happy to be called by the surgical team each day (mean 4.5/5). Wearability of the patch was high (mean 4.4/5), and no reports of skin irritation were mentioned. Overall data loss of vital signs measurements at home was 25%; both data loss and gap duration varied considerably among patients. Conclusions Remote monitoring of vital signs combined with telephone support from the surgical team was feasible and well perceived by all patients. Future studies need to evaluate the impact of home monitoring on patient outcome as well as the cost-effectiveness of this new approach.

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Association between complications and death within 30 days after noncardiac surgery

Cited by 210 publications

References 24 publications

Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study

Postoperative outcomes in surgical COVID-19 patients: a multicenter cohort study

Most deaths related to non-cardiac surgery occur outside operating room, finds study

Wireless Remote Home Monitoring of Vital Signs in Patients Discharged Early After Esophagectomy: Observational Feasibility Study

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