In Noncardiac Surgery, the Post-Op Period Is Riskiest

By Amy Orciari Herman

Edited by Susan Sadoughi, MD

Nearly all deaths related to noncardiac surgery occur after the procedure rather than during it, according to a large international study in the Canadian Medical Association Journal.

Researchers studied some 40,000 adults aged 45 and older who underwent inpatient noncardiac surgery between 2007 and 2013. Roughly 2% of the patients died within 30 days of surgery. Of these, approximately 1% died during surgery, 70% died during admission after surgery, and 29% died after hospital discharge. The median time to death was 11 days.

Three perioperative complications accounted for 45% of the deaths: major bleeding, postoperative myocardial injury, and sepsis. These complications occurred at a median of 0, 1, and 6 days, respectively, after surgery.

The researchers conclude that "efforts to improve postsurgical care — in the hospital and home setting — [have] the potential to reduce mortality." They suggest "focusing on the prevention, early identification and management of major bleeding, [myocardial injury] and sepsis."