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

Felix Kork (), Yafen Liang (), Adit A. Ginde, Xiaoyi Yuan, Rolf Rossaint, Hongfang Liu, Alex S. Evers and Holger K. Eltzschig ()
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Felix Kork: RWTH Aachen University
Yafen Liang: the University of Texas Health Science Center at Houston
Adit A. Ginde: University of Colorado School of Medicine
Xiaoyi Yuan: the University of Texas Health Science Center at Houston
Rolf Rossaint: RWTH Aachen University
Hongfang Liu: the University of Texas Health Science Center at Houston
Alex S. Evers: School of Medicine in St. Louis
Holger K. Eltzschig: the University of Texas Health Science Center at Houston

Nature Communications, 2025, vol. 16, issue 1, 1-9

Abstract: Abstract Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated with the lowest mortality (10.8%). This was followed by acute myocardial infarction (incidence 0.6%, mortality 15.6%), stroke (incidence 0.6%, mortality 13.1%), pulmonary embolism (incidence 0.3%, mortality 20.0%), liver injury (incidence 0.1%, mortality 68.7%), and acute respiratory distress syndrome (incidence 0.1%, mortality 44.7%). These findings help prioritize interventions for preventing or treating individual types of perioperative organ injury.

Date: 2025
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DOI: 10.1038/s41467-025-58161-2

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