Mortality and major postoperative complications within one year after vascular surgery: a prospective cohort study.

INTRODUCTION: Patients undergoing vascular procedures are prone to developing postoperative complications affecting short-term mortality. Prospective reports describing the incidence of long-term complications after vascular surgery are lacking.

OBJECTIVES: We aimed to describe the incidence of one-year complications after vascular surgery and to evaluate an association between myocardial injury after noncardiac surgery (MINS) and one-year mortality.

PATIENTS AND METHODS: This is a substudy of a large prospective cohort study - Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION). Recruitment took place in 28 centres across 14 countries from August 2007 to November 2013. We enrolled patients aged ≥45 years undergoing vascular surgery, receiving general or regional anaesthesia and hospitalised ≥1 night postoperatively. Plasma cardiac troponin T concentration was measured before surgery and on the 1st, 2nd, and 3rd postoperative day. Patients or their relatives were contacted one year after the procedure to assess the incidence of major postoperative complications.

RESULTS: We enrolled 2641 patients who underwent vascular surgery, 2534 (95.9%) of whom completed one-year follow-up. The mean age was 68.2 (SD 9.8) years, and the cohort was predominantly male (77.5%). The most frequent one-year complications were myocardial infarction (224/2534, 8.8%), amputation (187/2534, 7.4%) and congestive heart failure (67/2534, 2.6%). The one-year mortality rate was 8.8% (223/2534). MINS occurred in 633 (24.0%) patients and was associated with an increased one-year mortality (hazard ratio 2.82; 95%CI 2.14-3.72, P<.001).

CONCLUSIONS: The incidence of major postoperative complications after vascular surgery is high. The occurrence of MINS is associated with a near three-fold increase in one-year mortality.