• Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators, Jessica Spence, Yannick LeManach, Matthew TV Chan, C Y Wang, Alben Sigamani, Denis Xavier, Rupert Pearse, Pablo Alonso-Coello, Ignacio Garutti, Sadeesh K Srinathan, Emmanuelle Duceppe, Michael Walsh, Flavia Kessler Borges, German Malaga, Valsa Abraham, Atiya Faruqui, Otavio Berwanger, Bruce M Biccard, Juan Carlos Villar, Daniel I Sessler, Andrea Kurz, Clara K Chow, Carisi A Polanczyk, Wojciech Szczeklik, Gareth Ackland, Garg Amit X, Michael Jacka, Gordon H Guyatt, Robert J Sapsford, Colin Williams, Olga Lucia Cortes, Pierre Coriat, Ameen Patel, Maria Tiboni, Emilie P Belley-Côté, Stephen Yang, Diane Heels-Ansdell, Michael McGillion, Simon Parlow, Matthew Patel, Shirley Pettit, Salim Yusuf, and P J Devereaux.
• CMAJ. 2019 Jul 29; 191 (30): E830-E837.

BackgroundAmong adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications.MethodsWe conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model.ResultsWe included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2-3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9-2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6-6.8; AF 12.0%).InterpretationAmong adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration: ClinicalTrials.gov, no. NCT00512109.© 2019 Joule Inc. or its licensors.

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