• S R Moonesinghe, S Harris, M G Mythen, K M Rowan, F S Haddad, M Emberton, and M P W Grocott.
• UCL/UCLH Surgical Outcomes Research Centre, Department of Anaesthetics, University College Hospital, London NW1 2BU, UK UCL Centre for Anaesthesia, University College Hospital, London NW1 2BU, UK National Institute for Academic Anaesthesia's Health Services Research Centre, Royal College of Anaesthetists, 35 Red Lion Square, London WC1R 4SG, UK rmoonesinghe@gmail.com.
• Br J Anaesth. 2014 Dec 1; 113 (6): 977-84.

BackgroundPrevious studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity.MethodsWe did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival.ResultsData were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32-3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62-3.65), returning to baseline thereafter.ConclusionsProlonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications.© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

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