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Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population

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Abstract

Purpose

Perioperative mortality ranges from 0.4% to as high as nearly 12%. Currently, there are no large-scale studies looking specifically at the healthy surgical population alone. The primary objective of this study was to report 30-day mortality and morbidity in healthy patients and define any risk factors.

Methods

Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset, all patients assigned an American Society of Anesthesiologists physical status (ASA PS) classification score of 1 or 2 were included. Further patients were excluded if they had a comorbidity or underwent a procedure not likely to classify them as ASA PS 1 or 2. Multivariable logistic regression was performed to identify predictors of the outcomes, in which odds ratios (OR) and 95% confidence intervals (95% CI) were reported.

Results

There were 687,552 healthy patients included in the final analysis. Following surgery, 0.7, 7.0, and 0.7 per 1000 persons experienced 30-day mortality, sepsis, and stroke or myocardial infarction, respectively. Healthy patients greater than 80 years of age had the highest odds for mortality (OR 17.7, 95% CI 12.4–25.1, p < 0.001). Case duration was associated with increased mortality, especially in cases greater than or equal to 6 h (OR 3.0, 95% CI 2.0–4.5, p < 0.001).

Conclusions

Thirty-day mortality and morbidity is, as expected, lower in the healthy surgical population. Age may be an indication to further risk stratify patients that are ASA PS 1 or 2 to better reflect perioperative risk.

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References

  1. Braz LG, Modolo NS, do Nascimento Jr P, Bruschi BA, Castiglia YM, Ganem EM, de Carvalho LR, Braz JR. Perioperative cardiac arrest: a study of 53,718 anaesthetics over 9 years from a Brazilian teaching hospital. Br J Anaesth. 2006;96(5):569.

    Article  CAS  PubMed  Google Scholar 

  2. Fecho K, Lunney AT, Boysen PG, Rock P, Norfleet EA. Postoperative mortality after inpatient surgery: incidence and risk factors. Ther Clin Risk Manag. 2008;4(4):681.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, Dick AW. The surgical mortality probability model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg. 2012;255(4):696.

    Article  PubMed  Google Scholar 

  4. Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM. Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008;63(7):695.

    Article  CAS  PubMed  Google Scholar 

  5. Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E. Postoperative mortality in The Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010;112(5):1105.

    Article  PubMed  Google Scholar 

  6. Nunes JC, Braz JR, Oliveira TS, de Carvalho LR, Castiglia YM, Braz LG. Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in a tertiary teaching hospital. PLoS ONE. 2014;9(8):e104041.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Nunnally ME, O’Connor MF, Kordylewski H, Westlake B, Dutton RP. The incidence and risk factors for perioperative cardiac arrest observed in the national anesthesia clinical outcomes registry. Anesth Analg. 2015;120(2):364.

    Article  PubMed  Google Scholar 

  8. Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, Grounds RM, Bennett ED. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006;10(3):R81.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A, Rhodes A, European Surgical Outcomes Study group for the Trials groups of the European Society of Intensive Care M, the European Society of A. Mortality after surgery in Europe: a 7-day cohort study. Lancet. 1059;380(9847):2012.

    Google Scholar 

  10. van Zaane B, van Klei WA, Buhre WF, Bauer P, Boerma EC, Hoeft A, Metnitz P, Moreno RP, Pearse R, Pelosi P, Sander M, Vallet B, Pettila V, Vincent JL, Rhodes A, European Surgical Outcomes Study group for the Trials groups of the European Society of Intensive Care M, the European Society of a nonelective surgery at night and in-hospital mortality. Prospective observational data from the European Surgical Outcomes Study. Eur J Anaesthesiol. 2015;32(7):477.

    Article  PubMed  Google Scholar 

  11. Aronson WL, McAuliffe MS, Miller K. Variability in the American Society of Anesthesiologists Physical Status Classification Scale. AANA J. 2003;71(4):265.

    PubMed  Google Scholar 

  12. Sankar A, Johnson SR, Beattie WS, Tait G, Wijeysundera DN. Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. Br J Anaesth. 2014;113(3):424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Ranta S, Hynynen M, Tammisto T. A survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists. Acta Anaesthesiol Scand. 1997;41(5):629.

    Article  CAS  PubMed  Google Scholar 

  14. Mak PH, Campbell RC, Irwin MG, American Society of A. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care. 2002;30(5):633.

    CAS  PubMed  Google Scholar 

  15. Healthcare Cost and Utilization Project. Clinical classifications software for services and procedures. 2017. https://www.hcup-us.ahrq.gov/toolssoftware/ccs_svcsproc/ccssvcproc.jsp. Accessed July 2017.

  16. Johnson SE, Newton WP. Resource-based relative value units: a primer for academic family physicians. Fam Med. 2002;34(3):172.

    PubMed  Google Scholar 

  17. Lasko TA, Bhagwat JG, Zou KH, Ohno-Machado L. The use of receiver operating characteristic curves in biomedical informatics. J Biomed Inform. 2005;38(5):404.

    Article  PubMed  Google Scholar 

  18. Jawad M, Baigi A, Oldner A, Pearse RM, Rhodes A, Seeman-Lodding H, Chew MS. Swedish surgical outcomes study (SweSOS): an observational study on 30-day and 1-year mortality after surgery. Eur J Anaesthesiol. 2016;33(5):317.

    Article  PubMed  Google Scholar 

  19. Pelavski AD, De Miguel M, Alcaraz Garcia-Tejedor G, Villarino L, Lacasta A, Senas L, Rochera MI. Mortality, geriatric, and nongeriatric surgical risk factors among the eldest old: a prospective observational study. Anesth Analg. 2017;125(4):1329.

    Article  PubMed  Google Scholar 

  20. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373(23):2258.

    Article  CAS  PubMed  Google Scholar 

  21. Vogel TR, Dombrovskiy VY, Lowry SF. Trends in postoperative sepsis: are we improving outcomes? Surg Infect (Larchmt). 2009;10(1):71.

    Article  Google Scholar 

  22. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303.

    Article  CAS  PubMed  Google Scholar 

  23. Singh JA, Kwoh CK, Richardson D, Chen W, Ibrahim SA. Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis. Arthritis Care Res (Hoboken). 2013;65(7):1095.

    Article  Google Scholar 

  24. Theadom A, Cropley M. Effects of preoperative smoking cessation on the incidence and risk of intraoperative and postoperative complications in adult smokers: a systematic review. Tob Control. 2006;15(5):352.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Funding support from National Library of Medicine (NLM) training Grant number T15LM011271.

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Authors and Affiliations

  1. Department of Anesthesiology, University of California, San Diego, 200 West Arbor Dr, San Diego, CA, 92103, USA

    Rodney A. Gabriel, Jacklynn F. Sztain, Alison M. A’Court, Diana J. Hylton, Ruth S. Waterman & Ulrich Schmidt

  2. Department of Biomedical Informatics, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, CA, 92093-0881, USA

    Rodney A. Gabriel

Authors
  1. Rodney A. Gabriel
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  2. Jacklynn F. Sztain
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  3. Alison M. A’Court
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  4. Diana J. Hylton
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  5. Ruth S. Waterman
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  6. Ulrich Schmidt
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Contributions

RAG helped design the study, conduct the study, collect the data, analyze the data, and prepare the manuscript. JFS helped design the study, conduct the study, collect the data, analyze the data, and prepare the manuscript. AMA helped design the study, conduct the study, collect the data, analyze the data, and prepare the manuscript. DJH helped conduct the study, collect the data, analyze the data, and prepare the manuscript. RSW helped analyze the data and prepare the manuscript. US helped design the study, analyze the data, and prepare the manuscript.

Corresponding author

Correspondence to Rodney A. Gabriel.

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The authors declare that they have no conflicts of interest.

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Cite this article

Gabriel, R.A., Sztain, J.F., A’Court, A.M. et al. Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population. J Anesth 32, 112–119 (2018). https://doi.org/10.1007/s00540-017-2440-1

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  • DOI: https://doi.org/10.1007/s00540-017-2440-1

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