Reduced Long-Term Survival After Postoperative Complications in Major Gastrointestinal Surgery

Abstract

Purpose: We primarily evaluated the relationship between postoperative complications and long-term survival in patients undergoing major gastrointestinal surgery. Secondarily, we investigated the relationship between the severity and the number of complications and long-term survival. While postoperative complications are prevalent after major abdominal surgery and associated with increased mortality, the effect of their severity and accumulation remains insufficiently explored. Patients and Methods: 1989 adult patients undergoing major gastrointestinal surgery between July 2010 and April 2022 were retrospectively studied. Complications were classified using the Clavien-Dindo system. Kaplan-Meier analysis assessed long-term survival, Cox proportional hazards regression with time-dependent coefficients evaluated the impact of complications on mortality. Results: Median age was 64 years (IQR 53-74); 41.8% female and 63.0% of patients were diagnosed with malignancy. Elective procedures comprised 73.0% of cases. Complications occurred in 74.6% of patients. Mortality was higher in patients with complications (32.0%, 95% CI 29.7%-34.5%), compared to those without (21.7%, 95% CI 18.3-25.6%; P<0.001). Severe complications (Clavien-Dindo Grade >= III) were associated with a 15.01-fold higher hazard of mortality within 18 months postoperatively (95% CI 6.83-33.0; P<0.001). Conclusion: Postoperative complications significantly reduce long-term survival following major gastrointestinal surgery. Both their severity and frequency are critical determinants of poorer outcomes, emphasizing the need for effective prevention strategies. Plain Language Summary: Postoperative complications are a frequent occurrence following major gastrointestinal surgery and are known to increase the risk of death. However, the specific impact of both the number and severity of these complications on long-term survival remains inadequately defined. This retrospective study sought to clarify these associations by analysing the medical records of 1989 adult patients who underwent major gastrointestinal surgery between 2010 and 2022. The incidence, severity, and timing of postoperative complications were recorded, alongside long-term survival outcomes. Complications were observed in 75% of patients. The presence of any postoperative complication was associated with a significantly higher long-term mortality rate (32%) compared to patients without complications (22%). Importantly, patients who had severe complications were much more likely to die within 18 months after surgery-over 15 times higher risk compared to those without severe complications. These findings underscore that both the frequency and severity of postoperative complications are critical determinants of long-term survival following major gastrointestinal surgery. The results highlight the imperative for effective strategies aimed at the prevention and optimal management of postoperative complications to improve long-term patient outcomes in this population.