The Impact of Major Postoperative Complications on Long-Term Survival After Cardiac Surgery

Background. This study evaluated the impact of postoperative complications on long-term survival after cardiac surgery. Methods. Adults undergoing an index cardiac operation from January 2010 to December 2017 were included. Patients were stratified by the number and type of major complications as defined by The Society of Thoracic Surgeons. Failure to rescue was defined as mortality after a complication that occurred before hospital discharge. Long-term mortality among patients with complications was defined as a postcomplication death occurring after hospital discharge. Multivariable Cox regression was used for risk adjustment. Results. In all, 9532 patients were included in the study, and 16.8% (n = 1600) had a major postoperative complication. Operative mortality was 0.8% for patients with no complications. Early failure to rescue increased as the number of complications increased (7.5%, 28.1%, and 51.5% for one, two, and three or more complications, respectively; P <.0001). Median length of intensive care unit and hospital stay ranged, respectively, from 38 hours and 7 days for patients with no complications to 359 hours and 23 days for patients with three or more complications (P <.0001). The adverse impact of complications on survival persisted at 1-year follow-up (3.5%, 18.8%, 52.1%, and 77.9%; P <.0001) and 5-year follow-up (10.8%, 33%, 61.8%, and 77.9%; P <.0001) for patients with no complications or one, two, or three or more complications, respectively. Risk-adjusted analysis confirmed these findings (P <.0001). Furthermore, 5-year survival conditional on 30-day survival ranged from 85.1% to 41.5% for patients with no complications versus three or more complications (P <.0001). Conclusions. Postoperative complications after cardiac surgery, particularly when occurring in combination, have a profound impact on long-term survival, even after excluding early postoperative deaths. (C) 2020 by The Society of Thoracic Surgeons