Changes in Prognosis After the First Postoperative Complication

BACKGROUND: Postoperative complications are common in the Medicare population, yet no study has formally quantified the change in prognosis that occurs after a broad range of first complications. OBJECTIVE: We sought to estimate the relative severity of 24 first postoperative complications. RESEARCH DESIGN: We undertook a multivariate matched, population-based, case-control study of death after surgery in a sample of 1362 Pennsylvania Medicare patients. SUBJECTS: Cases (681 deaths) were selected randomly using claims from 1995-1996. Models were developed to scan all Pennsylvania claims, looking for similar controls that did not die. MEASURES: Charts were abstracted, complications identified, and models were constructed to estimate the odds of dying after any 1 of 24 first postoperative complications. RESULTS: The odds of dying within 60 days increased 3.4-fold (95% confidence interval [CI] 2.5-4.7) in patients with complications as compared with those without complications. A first complication of respiratory compromise was associated with a 7.2-fold increase in the odds of dying (95% CI 4.5-11.6). The first complications of pneumonia or congestive heart failure were associated with, respectively, 5-fold (95% CI 2.1-12.1) and 5.1-fold (2.3-11.1) increases in odds of dying as compared with no complication. CONCLUSIONS: First complications after surgery, even seemingly mild ones, may radically alter the patient's risk of death. First complications often begin the cascade of complications that end in death. Caregivers should consider the first complication as a timely signal of a changed clinical situation demanding a reevaluation of the patient's care. Researchers may use these estimates to determine the relative severity of a broad range of first or early complications

Complication · Confidence interval · Intensive care medicine · Logistic regression · Multivariate analysis · Odds · Odds ratio · Pneumonia · Population · Cardiac, Anesthesia and Surgical Outcomes · Enhanced Recovery After Surgery · Internal Medicine · Medicine · Sepsis Diagnosis and Treatment · Surgery

• Failure-to-Rescue

  Jacob Needleman, Jack Needleman et al.•Medical Care•2007

  Incluir item

• Failure-to-Rescue After Acute Myocardial Infarction

  Jeffrey H Silber, Alexander F Arriaga et al.•Medical Care•2018

  Incluir item

• Bias Reduction Using Mahalanobis-Metric Matching

  Donald B Rubin•Biometrics•1980

  Incluir item

• Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

  Linda H Aiken•JAMA•2002

  Incluir item

• Nurse-Staffing Levels and the Quality of Care in Hospitals

  Jacob Needleman, Jack Needleman et al.•New England Journal of Medicine•2002

  Incluir item

• The central role of the propensity score in observational studies for causal effects

  Paul R Rosenbaum, Donald B Rubin•Biometrika•1983

  Incluir item

• Constructing a Control Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score

  Paul R Rosenbaum, Donald B Rubin•The American Statistician•1985

  Incluir item

• Can Administrative Data Be Used to Compare Postoperative Complication Rates Across Hospitals

  Patrick S Romano, Benjamin K Chan et al.•Medical Care•2002

  Incluir item

• Apache-L

  Laurence F McMahon, Rodney A Hayward et al.•Medical Care•1992

  Incluir item

• Hospital and Patient Characteristics Associated With Death After Surgery

  Jeffrey H Silber, Sharon Vegh Williams et al.•Medical Care•1992

  Incluir item

• Multivariate Matching and Bias Reduction in the Surgical Outcomes Study

  Jeffrey H Silber, Paul R Rosenbaum et al.•Medical Care•2001

  Incluir item