The riskiest period for operated patients is not in the operating room

The deadliest period for many operated patients is not when they are on the operating table, but during their convalescence at the hospital and after they return home, suggests a new study.

For this study, the researchers looked at the results for more than 40,000 patients aged 45 and over who had non-cardiac surgery in 28 hospitals in 14 countries. The researchers monitored the complications and deaths of patients within 30 days of the operation.

Overall, five people, less than 1% of the patients, died at the operating table and another 500 patients, or 70%, died in the hospital. Another 210 deaths, or 29%, occurred only after the patients were sent home.

Nearly half of all deaths were badociated with three complications: major bleeding, heart damage and blood infections.

"Many families anxiously wait for surgeon if their loved one has survived the operation, but our research shows that very few deaths occur in the operating room," said Dr. PJ Devereaux, lead author of the Study and director of the division. perioperative care at McMaster University in Canada.

"Our research now shows that there is a need to focus on post-operative care and transitional home care to improve outcomes," Devereaux said via e-mail.

Around the world, 100% of patients aged 45 and older undergo non-cardiac surgery each year, say researchers in CMAJ.

The research team notes that a wide range of technological and medical advances have made surgery safer and less invasive in recent years. But at the same time, patients also arrive at the sick hospital and are sent home with complex care needs that would have already resulted in long hospitalization.

In the study, about half of the patients were hypertensive, one in five were diabetic and 13% had coronary artery disease.

More than a third of them only intervened for low-risk procedures that were not emergencies. Most of the others had major general operations, orthopedic, urological, gynecological, vascular or neurological.

Patients who had significant bleeding after surgery were more than twice as likely to die within 30 days as patients without this complication.

And patients who developed heart damage even though they did not have heart surgery also risked dying more than twice.

Patients with sepsis, a serious blood infection, were five times more likely to die within 30 days than uninfected people.

The study was not a controlled experiment designed to identify potential complications that resulted in death.

Inflammation could be a common denominator in the most responsible complications of death, said Barnaby Charles Reeves of the University of Bristol in the UK, author of an editorial accompanying the study.

"The surgery causes an inflammatory reaction to the body," said Reeves by e-mail. "This can lead to a mono or multi-organic failure [kidney, heart, lungs, sepsis etc.] which leads to death. "

Patients may also not recognize that something is wrong when they leave anesthesia or take narcotic pain relievers after surgery, Devereaux said.

"This makes patients after surgery vulnerable to delays in the recognition of complications and therefore to delays in treatment," said Devereaux.

Surgery also activates the inflammatory, stress and coagulation systems of patients. The activation of these systems can also predispose patients to major complications. Patients should advocate and support research on improved surveillance techniques after surgery, which can help identify ways to reduce the risk of death after surgery.