Association between complications and mortality after cardiac surgery: Results from the Vascular Events in Surgery Patients Cohort Evaluation cardiac surgery prospective cohort study.

Abstract

The most prognostically important complications after cardiac surgery to target for prevention remain uncertain. We aimed to assess the relationship between postoperative complications and mortality at 30 days and 1 year after cardiac surgery and rank the complications by their contribution to mortality. We completed an analysis of 15,550 patients from the Vascular Events in Surgery Patients Cohort Evaluation (VISION) Cardiac Surgery Prospective Cohort Study, which enrolled 15,971 patients who underwent cardiac surgery from 24 centers in 12 countries. The primary outcome was all-cause mortality at 30 days and 1 year. Population attributable fractions (PAFs) were calculated to estimate the proportion of deaths potentially attributable to each complication. All-cause mortality occurred in 460 patients (3.0%) at 30 days and in 399 (2.6%) between 31 days and 1 year, totaling 859 deaths (5.5%) at 1 year. The 4 complications occurring within 30 days with the largest PAFs for 30-day mortality were acute kidney injury (2612 patients [16.8%]; adjusted hazard ratio [aHR], 4.47; 95% CI, 3.52-5.67; PAF, 37%), bleeding (1491 patients [9.6%]; aHR, 2.39; 95% CI, 1.87-3.06; PAF, 12%), infection (2260 [14.5%]; aHR, 1.95; 95% CI, 1.47-2.57; PAF, 12%), and myocardial injury after cardiac surgery (1686 patients [10.8%]; aHR, 2.01; 95% CI, 1.58-2.54; PAF, 10%). This international study suggests that approximately 1 in 3 deaths after cardiac surgery are associated with acute kidney injury. Targeted prevention of acute kidney injury, infections, bleeding, and myocardial injury holds promise for reducing mortality in patients after cardiac surgery.