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

Summary

In a nationwide German cohort of 28,350,953 surgeries, perioperative organ injury occurred in 4.4% and was associated with nine-fold higher odds of death and an 11.2-day longer stay. Although perioperative ARDS was rare (0.1%), it carried very high in-hospital mortality (44.7%), highlighting prevention and early detection as priorities.

Key Findings

• Nationwide cohort of 28,350,953 surgical cases with 1.4% in-hospital mortality.
• Perioperative organ injury in 4.4% associated with nine-fold higher odds of death and +11.2 days length of stay.
• Organ-specific outcomes: AKI 2.0% incidence (25.0% mortality); delirium 1.5% (10.8%); AMI 0.6% (15.6%); stroke 0.6% (13.1%); PE 0.3% (20.0%); liver injury 0.1% (68.7%); ARDS 0.1% (44.7%).

Clinical Implications

Use these data to inform perioperative risk models, surveillance pathways (e.g., AKI, ARDS bundles), and resource allocation. High-mortality injuries (e.g., liver injury, ARDS) warrant targeted prevention and rapid response protocols.

Limitations

• Retrospective administrative data with potential misclassification and residual confounding; causality cannot be inferred.
• Granular clinical variables (e.g., ventilator settings, fluid balance) and long-term outcomes are not available.

Future Directions

Link administrative data to granular clinical and physiologic datasets; test targeted prevention bundles for high-mortality injuries; external validation in other countries and causal inference approaches.