@article{moonesinghe_survival_2014,
	title = {Survival after postoperative morbidity: a longitudinal observational cohort study.},
	volume = {113},
	copyright = {(c) The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.},
	issn = {1471-6771 0007-0912},
	doi = {10.1093/bja/aeu224},
	abstract = {BACKGROUND: Previous 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. METHODS: We 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. RESULTS: Data 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{\textless}0.001;  95\% CI 2.28-5.42) and for the next 2 yr of 2.44 (P{\textless}0.001; 95\% CI 1.62-3.65), returning to baseline thereafter. CONCLUSIONS: Prolonged 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.},
	language = {eng},
	number = {6},
	journal = {British journal of anaesthesia},
	author = {Moonesinghe, S. R. and Harris, S. and Mythen, M. G. and Rowan, K. M. and Haddad, F. S. and Emberton, M. and Grocott, M. P. W.},
	month = dec,
	year = {2014},
	pmid = {25012586},
	pmcid = {PMC4235571},
	keywords = {Aged, Cohort Studies, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Length of Stay/statistics \& numerical data, London/epidemiology, Longitudinal Studies, Male, Middle Aged, Morbidity, Mortality, Premature, Postoperative Complications/*mortality, Postoperative Period, Quality Indicators, Health Care, Specialties, Surgical, complications, complications, morbidity, complications, neurological, surgery, non-cardiac},
	pages = {977--984},
}

{"_id":"waoLydbNFatiyqA7y","bibbaseid":"moonesinghe-harris-mythen-rowan-haddad-emberton-grocott-survivalafterpostoperativemorbidityalongitudinalobservationalcohortstudy-2014","downloads":0,"creationDate":"2019-01-22T11:20:08.510Z","title":"Survival after postoperative morbidity: a longitudinal observational cohort study.","author_short":["Moonesinghe, S. R.","Harris, S.","Mythen, M. G.","Rowan, K. M.","Haddad, F. S.","Emberton, M.","Grocott, M. P. W."],"year":2014,"bibtype":"article","biburl":"https://api.zotero.org/groups/2278468/items?key=VdI1Arfo5ouMqRbfhtn5L0oK&format=bibtex&limit=100","bibdata":{"bibtype":"article","type":"article","title":"Survival after postoperative morbidity: a longitudinal observational cohort study.","volume":"113","copyright":"(c) The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.","issn":"1471-6771 0007-0912","doi":"10.1093/bja/aeu224","abstract":"BACKGROUND: Previous 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. METHODS: We 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. RESULTS: Data 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\\textless0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P\\textless0.001; 95% CI 1.62-3.65), returning to baseline thereafter. CONCLUSIONS: Prolonged 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.","language":"eng","number":"6","journal":"British journal of anaesthesia","author":[{"propositions":[],"lastnames":["Moonesinghe"],"firstnames":["S.","R."],"suffixes":[]},{"propositions":[],"lastnames":["Harris"],"firstnames":["S."],"suffixes":[]},{"propositions":[],"lastnames":["Mythen"],"firstnames":["M.","G."],"suffixes":[]},{"propositions":[],"lastnames":["Rowan"],"firstnames":["K.","M."],"suffixes":[]},{"propositions":[],"lastnames":["Haddad"],"firstnames":["F.","S."],"suffixes":[]},{"propositions":[],"lastnames":["Emberton"],"firstnames":["M."],"suffixes":[]},{"propositions":[],"lastnames":["Grocott"],"firstnames":["M.","P.","W."],"suffixes":[]}],"month":"December","year":"2014","pmid":"25012586","pmcid":"PMC4235571","keywords":"Aged, Cohort Studies, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Length of Stay/statistics & numerical data, London/epidemiology, Longitudinal Studies, Male, Middle Aged, Morbidity, Mortality, Premature, Postoperative Complications/*mortality, Postoperative Period, Quality Indicators, Health Care, Specialties, Surgical, complications, complications, morbidity, complications, neurological, surgery, non-cardiac","pages":"977–984","bibtex":"@article{moonesinghe_survival_2014,\n\ttitle = {Survival after postoperative morbidity: a longitudinal observational cohort study.},\n\tvolume = {113},\n\tcopyright = {(c) The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.},\n\tissn = {1471-6771 0007-0912},\n\tdoi = {10.1093/bja/aeu224},\n\tabstract = {BACKGROUND: Previous 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. METHODS: We 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. RESULTS: Data 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{\\textless}0.001; 95\\% CI 2.28-5.42) and for the next 2 yr of 2.44 (P{\\textless}0.001; 95\\% CI 1.62-3.65), returning to baseline thereafter. CONCLUSIONS: Prolonged 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.},\n\tlanguage = {eng},\n\tnumber = {6},\n\tjournal = {British journal of anaesthesia},\n\tauthor = {Moonesinghe, S. R. and Harris, S. and Mythen, M. G. and Rowan, K. M. and Haddad, F. S. and Emberton, M. and Grocott, M. P. W.},\n\tmonth = dec,\n\tyear = {2014},\n\tpmid = {25012586},\n\tpmcid = {PMC4235571},\n\tkeywords = {Aged, Cohort Studies, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Length of Stay/statistics \\& numerical data, London/epidemiology, Longitudinal Studies, Male, Middle Aged, Morbidity, Mortality, Premature, Postoperative Complications/*mortality, Postoperative Period, Quality Indicators, Health Care, Specialties, Surgical, complications, complications, morbidity, complications, neurological, surgery, non-cardiac},\n\tpages = {977--984},\n}\n\n","author_short":["Moonesinghe, S. 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