Impact of perioperative organ injury on morbidity and mortality in 28 million surgical patients.

Summary

In a nationwide cohort of 28.3 million surgeries, perioperative organ injury occurred in 4.4% and was associated with ninefold higher odds of death and 11.2 additional hospital days. Incidence and mortality varied by organ injury type, with acute kidney injury most frequent and liver injury carrying the highest mortality.

Key Findings

• Among 28,350,953 surgeries, perioperative organ injury occurred in 4.4% and increased odds of death ninefold.
• Organ injury prolonged hospitalization by an average of 11.2 days.
• Acute kidney injury was most frequent (2.0%, 25.0% mortality), while liver injury, though rarer (0.1%), had the highest mortality (68.7%).

Clinical Implications

Perioperative programs should target high-burden, high-mortality injuries (e.g., AKI, ARDS, liver injury) with specific bundles and monitoring; risk stratification and early detection protocols can be aligned with these quantified risks.

Limitations

• Administrative data subject to coding errors and residual confounding; causal inference is limited.
• Lack of granular intraoperative variables (e.g., fluids, hemodynamics) that may mediate risk.

Future Directions

Linkage with intraoperative physiologic and therapy data to identify modifiable drivers; prospective implementation of targeted prevention bundles and evaluation via learning health systems.