Most deaths related to non-cardiac surgery occur after surgery and after discharge from the hospital.

This is not the operating room that is risky for patients undergoing non-cardiac surgery; it's the payback period. According to a large international study, only 0.7% of deaths in these patients occurred in the operating room, compared with 29% after discharge from the hospital. The study, which included patients from 28 centers in 14 countries, was published CMAJ (Journal of the Canadian Medical Association).

"Since most deaths in adults undergoing non-cardiac surgery occur not in the operating room, but after, efforts to improve postoperative care at the hospital and at home have a substantial potential for reducing mortality, "says the author, Dr. PJ Devereaux, of McMaster University, Hamilton, Ontario.

The study, which involved 40,004 adults aged 45 and over from North and South America, Asia, Europe, Africa and Africa. Australia operated between 2007 and 2013, found that 1.8% of patients had died within 30 days of non-cardiac surgery. Major bleeding, heart muscle damage and severe infections (sepsis) were the cause of a large proportion of deaths (45%).

"About 100 million adults aged 45 and over undergo non-cardiac surgery each year around the world, so an estimated 1.8 million people die from complications in less than 30 days," he said. said Dr. Devereaux. "This means that death after surgery is a major health burden in the world."

The authors suggest that solutions focused on prevention, early identification and close management of bleeding, heart problems and infections could help reduce these preventable deaths.

The published data come from the VISION study on vascular events in non-cardiac surgery patients funded by more than 70 sources.

In a related commentary, Dr. Barnaby Reeves, of the Bristol School of Medicine, at the University of Bristol, UK, salutes the results obtained by the researchers of the study, but warns policy makers against bias inherent in such studies, taking into account the observed relationships between complications and mortality.

"Association between Complications and Deaths within 30 Days of Noncardiac Surgery" is published on July 29, 2019.