Anesthetic Management and One-Year Mortality After Noncardiac Surgery

TLDR

Little is known about the effect of anesthetic management on long‑term outcomes. The study aimed to determine whether first‑year mortality after major noncardiac surgery with general anesthesia is associated with demographic, preoperative, surgical, or intraoperative variables. The authors conducted a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia. One‑year mortality was 5.5% overall (10.3% in patients ≥65 years) and was independently predicted by patient comorbidity (RR ≈ 16), cumulative deep hypnotic time (RR ≈ 1.24 per hour), and intraoperative systolic hypotension (RR ≈ 1.04 per minute), indicating that anesthetic management influences long‑term outcomes.

Abstract

Little is known about the effect of anesthetic management on long-term outcomes. We designed a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia to determine if mortality in the first year after surgery is associated with demographic, preoperative clinical, surgical, or intraoperative variables. One-year mortality was 5.5% in all patients (n = 1064) and 10.3% in patients > or =65 yr old (n=243). Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P <0.0001), cumulative deep hypnotic time (Bispectral Index <45) (relative risk=1.244/h; P=0.0121) and intraoperative systolic hypotension (relative risk=1.036/min; P=0.0125). Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated.