Long-Term Survival After Complications Following Major Abdominal Surgery

Jennifer Straatman, Miguel A Cuesta, Elly S M de Lange-de Klerk, Donald L van der Peet, Jennifer Straatman, Miguel A Cuesta, Elly S M de Lange-de Klerk, Donald L van der Peet

Abstract

Introduction: Postoperative complications have been associated with decreased long-term survival in cardiac, orthopedic, and vascular surgery. For major abdominal surgery research, conflicting evidence is reported in smaller studies. The aim of this study was to assess the effect of complications on long-term survival in major abdominal surgery.

Material and methods: An observational cohort study was conducted of 861 consecutive patients that underwent major abdominal surgery between January 2009 and March 2014, with prospective assessment of the survival status. The effect of postoperative complications on survival was assessed.

Results: Postoperative complications were associated with decreased survival, even after applying correction for 30-day mortality (p < 0.001). Stratified Cox regression analysis depicted postoperative complications to be an important predictor for survival in upper gastrointestinal and female hepatopancreaticobiliary patients. Correction was applied for age, gender, BMI, ASA classification, radicality, and positive lymph node status.

Conclusion: These results further indicate the importance of prevention and early diagnosis and treatment of complications. Etiological factors are believed to be both sustained levels of inflammatory markers, as well as attenuated immune response in malignancy with subsequent cancer cell seeding. Future research should aim to prevent and early diagnose postoperative complications to prevent morbidity and mortality not only in the early postoperative phase, but also in the long term.

Keywords: Major abdominal surgery; Postoperative complications; Survival.

Figures

Fig. 1
Fig. 1
a Kaplan-Meier curve stratified for patients with no, minor or major complications. b Kaplan-Meier curve excluding patients with less than 30-day follow-up. Arrow indicates differences in curve for major complications
Fig. 2
Fig. 2
Stratified analysis of survival in uncomplicated and complicated cases in upper GI, HPB, and colorectal surgery. p Values depicted for log-rank test in each group

References

    1. Centraal Bureau voor de Statistiek (CBS). Operaties in het ziekenhuis; soort opname, leeftijd en geslacht, 1995–2010. . 2012; accessed 19 july 2014.
    1. Straatman J, Cuesta MA, Gisbertz SS, van der Peet DL. Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery. Rev Esp Enferm Dig. 2014;106:515–521.
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, Participants in the VANSQIP Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326–341.
    1. Cecconi M, Corredor C, Arulkumaran N, Abuella G, Ball J, Grounds RM, Hamilton M, Rhodes A. Clinical review: Goal-directed therapy-what is the evidence in surgical patients? The effect on different risk groups. Critical care. 2013;17:209. doi: 10.1186/cc11823.
    1. Silber JH, Rosenbaum PR, Trudeau ME, Chen W, Zhang X, Kelz RR, Mosher RE, Even-Shoshan O. Changes in prognosis after the first postoperative complication. Medical Care. 2005;43:122–131. doi: 10.1097/00005650-200502000-00005.
    1. Hii MW, Smithers BM, Gotley DC, Thomas JM, Thomson I, Martin I, Barbour AP. Impact of postoperative morbidity on long-term survival after oesophagectomy. The British Journal of Surgery. 2013;100:95–104. doi: 10.1002/bjs.8973.
    1. D’Annoville T, D’Journo XB, Trousse D, Brioude G, Dahan L, Seitz JF, Doddoli C, Thomas PA. Respiratory complications after oesophagectomy for cancer do not affect disease-free survival. European Journal of Cardio-Thoracic Surgery: official journal of the European Association for Cardio-thoracic Surgery. 2012;41:e66–e73. doi: 10.1093/ejcts/ezs080.
    1. Okamura Y, Takeda S, Fujii T, Sugimoto H, Nomoto S, Nakao A. Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma. Journal of Surgical Oncology. 2011;104:814–821. doi: 10.1002/jso.21977.
    1. Kamphues C, Bova R, Schricke D, Hippler-Benscheidt M, Klauschen F, Stenzinger A, Seehofer D, Glanemann M, Neuhaus P, Bahra M. Postoperative complications deteriorate long-term outcome in pancreatic cancer patients. Ann Surg Oncol. 2012;19:856–863. doi: 10.1245/s10434-011-2041-4.
    1. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications; five year experience. Ann Surg. 2009;250:187–196. doi: 10.1097/SLA.0b013e3181b13ca2.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications; a new proposal with evaluation in a cohort of 6336 patient and results of a survey. Ann Surg. 2004;240:205–213. doi: 10.1097/.
    1. Rueth NM, Parsons HM, Habermann EB, Groth SS, Virnig BA, Tuttle TM, Andrade RS, Maddaus MA, D’Cunha J. The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: a population-based survival analysis. Ann Surg. 2011;254:368–374. doi: 10.1097/SLA.0b013e31822150fe.
    1. Elfstrom KM, Hatefi D, Kilgo PD, Puskas JD, Thourani VH, Guyton RA, Halkos ME. What happens after discharge? An analysis of long-term survival in cardiac surgical patients requiring prolonged intensive care. J Card Surg. 2012;27:13–19. doi: 10.1111/j.1540-8191.2011.01341.x.
    1. Kang J, Choi GS, Oh JH, Kim NK, Park JS, Kim MJ, Lee KY, Baik SH. Multicenter Analysis of Long-Term Oncologic Impact of Anastomotic Leakage After Laparoscopic Total Mesorectal Excision: The Korean Laparoscopic Colorectal Surgery Study Group. Medicine. 2015;94 doi: 10.1097/MD.0000000000001202.
    1. Risnes I, Abdelnoor M, Almdahl SM, Svennevig JL. Mediastinitis after coronary artery bypass grafting risk factors and long-term survival. The Annals of Thoracic Surgery. 2010;89:1502–1509. doi: 10.1016/j.athoracsur.2010.02.038.
    1. van Heijl M, Gooszen JA, Fockens P, Busch OR, van Lanschot JJ, van Berge Henegouwen MI. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg. 2010;251:1064–1069. doi: 10.1097/SLA.0b013e3181deb4b7.
    1. El Nakeeb A, El Shobary M, El Dosoky M, Nabeh A, El Sorogy M, El Eneen AA, Abu Zeid M, Elwahab MA. Prognostic factors affecting survival after pancreaticoduodenectomy for pancreatic adenocarcinoma (single center experience) Hepato-gastroenterology. 2014;61:1426–1438.
    1. Castelli GP, Pognani C, Meisner M, Stuani A, Bellomi D, Sgarbi L. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Critical care. 2004;8:R234–R242. doi: 10.1186/cc2877.
    1. Casserly I, Topol E. Convergence of atherosclerosis and Alzheimer’s disease: inflammation, cholesterol, and misfolded proteins. Lancet. 2004;363:1139–1146. doi: 10.1016/S0140-6736(04)15900-X.
    1. Stack AG, Donigiewicz U, Abdalla AA, Weiland A, Casserly LF, Cronin CJ, Nguyen HT, Hannigan A. Plasma fibrinogen associates independently with total and cardiovascular mortality among subjects with normal and reduced kidney function in the general population. QJM. 2014;107:701–713. doi: 10.1093/qjmed/hcu057.
    1. Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, Naritake Y, Hosokawa T, Kajiwara T. Suppression of cellular immunity by surgical stress. Surgery. 2000;127:329–336. doi: 10.1067/msy.2000.103498.
    1. Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. British Journal of Anaesthesia. 2013;110:690–701. doi: 10.1093/bja/aet068.
    1. Cuesta JM, Singer M. The stress response and critical illness: a review. Crit Care Med. 2012;40:3283–3289. doi: 10.1097/CCM.0b013e31826567eb.
    1. Toner A, Hamilton M. The long-term effects of postoperative complications. Curr Opin Crit Care. 2013;19:364–368. doi: 10.1097/MCC.0b013e3283632f77.
    1. Kim I, Kim B, Kim Y. Factors Affecting Use and Delay (≥8 Weeks) of Adjuvant Chemotherapy after Colorectal Cancer Surgery and the Impact of Chemotherapy-Use and Delay on Oncologic Outcomes. PloS one. 2015;10 doi: 10.1371/journal.pone.0138720.
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377. doi: 10.1056/NEJMoa010307.
    1. Rivers EP, Coba V, Whitmill M. Early goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature. Curr Opin Anaesthesiol. 2008;21:128–140. doi: 10.1097/ACO.0b013e3282f4db7a.
    1. Straatman J, Cuesta MA, Schreurs WH, Dwars BJ, Cense HA, Rijna H, Sonneveld DJA, den Boer FC, de Lange - de Klerk ESM, van der Peet DL. The PRECious trial PREdiction of Complications, a step-up approach, CRP first followed by CT-scan imaging to ensure quality control after major abdominal surgery: study protocol for a stepped-wedge trial. Trials. 2015;16:382. doi: 10.1186/s13063-015-0903-y.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera