Determinants of Long-term Surgical Outcomes in Sweden. Searching for Modifiable Factors
Jawad, Monir LU
(2026)
In Lund University, Faculty of Medicine. Doctoral Dissertation Series
- Abstract
- As populations age and multimorbidity becomes increasingly prevalent, the demand for high risk surgical procedures continues to rise. Although short term surgical outcomes in Sweden are generally favourable, evidence regarding long term morbidity and mortality following non cardiac surgery remains limited. This thesis investigates perioperative determinants of long term outcomes, with the aim of identifying predictors of mortality and morbidity and clarifying the role of postoperative care in shaping recovery trajectories.
Four principal studies were conducted using registry data and prospective cohorts. The Swedish Surgical Outcomes Study demonstrated that while 30 day mortality was low (1.8%), it increased to 8.5% at one year, with... (More) - As populations age and multimorbidity becomes increasingly prevalent, the demand for high risk surgical procedures continues to rise. Although short term surgical outcomes in Sweden are generally favourable, evidence regarding long term morbidity and mortality following non cardiac surgery remains limited. This thesis investigates perioperative determinants of long term outcomes, with the aim of identifying predictors of mortality and morbidity and clarifying the role of postoperative care in shaping recovery trajectories.
Four principal studies were conducted using registry data and prospective cohorts. The Swedish Surgical Outcomes Study demonstrated that while 30 day mortality was low (1.8%), it increased to 8.5% at one year, with persistent excess mortality compared with the general population. Independent predictors included advanced age, comorbidity burden, and urgent surgery, whereas admission to intensive care or prolonged post anaesthesia care did not confer survival benefit. A second study revealed that prior surgical exposure was paradoxically associated with improved long term survival among intensive care patients, suggesting surgical patients may derive greater benefit from critical care resources.
The third study identified perioperative myocardial injury, measured by high sensitivity cardiac troponin T, as a strong predictor of 30 day mortality and major cardiovascular and cerebrovascular events as a composite outcome measure. The fourth study examined postoperative nadir haemoglobin levels and found that they were not independently associated with the same composite outcome of the third study measured in one-year follow-up. Age and hospital type were predictors for worse long-term outcomes.
In conclusion, long term outcomes after non cardiac surgery are shaped by patient and procedure related factors identifiable perioperatively. Enhanced risk stratification with optimised perioperative management and international standardisation of care are essential to improve survival and recovery in high risk surgical populations. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1e39a671-dcf8-42f4-840e-d78eb48413e2
- author
- Jawad, Monir
LU
- supervisor
- opponent
-
- Professor Emeritus Naredi, Silvana, University of Gothenburg
- organization
- publishing date
- 2026
- type
- Thesis
- publication status
- published
- subject
- keywords
- Perioperative Care, Postoperative Complications, Surgical Procedures, Risk Factors, Mortality, Morbidity, Critical Care, Intensive Care Units, Myocardial Ischemia, Troponin T, Haemoglobin, Anaemia, Comorbidity, Aged, Frailty, Anaesthesia Recovery Period, Registries, Prospective Studies, Outcome Assessment, Global Health, Blood Transfusion, Ventilation, Pulmonary Complications, Patient Safety, Evidence-Based Practice
- in
- Lund University, Faculty of Medicine. Doctoral Dissertation Series
- issue
- 2026:62
- pages
- 70 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Segerfalksalen, BMC A10, Sölvegatan 17 i Lund
- defense date
- 2026-04-29 13:00:00
- ISSN
- 1652-8220
- ISBN
- 978 91 8021 860 3
- language
- English
- LU publication?
- yes
- id
- 1e39a671-dcf8-42f4-840e-d78eb48413e2
- date added to LUP
- 2026-03-30 14:18:40
- date last changed
- 2026-04-02 10:52:20
@phdthesis{1e39a671-dcf8-42f4-840e-d78eb48413e2,
abstract = {{As populations age and multimorbidity becomes increasingly prevalent, the demand for high risk surgical procedures continues to rise. Although short term surgical outcomes in Sweden are generally favourable, evidence regarding long term morbidity and mortality following non cardiac surgery remains limited. This thesis investigates perioperative determinants of long term outcomes, with the aim of identifying predictors of mortality and morbidity and clarifying the role of postoperative care in shaping recovery trajectories.<br/>Four principal studies were conducted using registry data and prospective cohorts. The Swedish Surgical Outcomes Study demonstrated that while 30 day mortality was low (1.8%), it increased to 8.5% at one year, with persistent excess mortality compared with the general population. Independent predictors included advanced age, comorbidity burden, and urgent surgery, whereas admission to intensive care or prolonged post anaesthesia care did not confer survival benefit. A second study revealed that prior surgical exposure was paradoxically associated with improved long term survival among intensive care patients, suggesting surgical patients may derive greater benefit from critical care resources.<br/>The third study identified perioperative myocardial injury, measured by high sensitivity cardiac troponin T, as a strong predictor of 30 day mortality and major cardiovascular and cerebrovascular events as a composite outcome measure. The fourth study examined postoperative nadir haemoglobin levels and found that they were not independently associated with the same composite outcome of the third study measured in one-year follow-up. Age and hospital type were predictors for worse long-term outcomes.<br/>In conclusion, long term outcomes after non cardiac surgery are shaped by patient and procedure related factors identifiable perioperatively. Enhanced risk stratification with optimised perioperative management and international standardisation of care are essential to improve survival and recovery in high risk surgical populations.}},
author = {{Jawad, Monir}},
isbn = {{978 91 8021 860 3}},
issn = {{1652-8220}},
keywords = {{Perioperative Care; Postoperative Complications; Surgical Procedures; Risk Factors; Mortality; Morbidity; Critical Care; Intensive Care Units; Myocardial Ischemia; Troponin T; Haemoglobin; Anaemia; Comorbidity; Aged; Frailty; Anaesthesia Recovery Period; Registries; Prospective Studies; Outcome Assessment; Global Health; Blood Transfusion; Ventilation; Pulmonary Complications; Patient Safety; Evidence-Based Practice}},
language = {{eng}},
number = {{2026:62}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine. Doctoral Dissertation Series}},
title = {{Determinants of Long-term Surgical Outcomes in Sweden. Searching for Modifiable Factors}},
url = {{https://lup.lub.lu.se/search/files/246194008/Avhandling_Monir_Jawad_LUCRIS.pdf}},
year = {{2026}},
}