The ‘long shadow’ of perioperative complications: association with increased risk of death up to 1 year after surgery

Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a ‘long shadow’ of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report ‘perioperative’ complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.