Abstract
The objective was to assess observed-to-expected in-hospital postoperative 30-day mortality and to identify associated risks. A single centre, retrospective study was performed in Geneva University Hospitals, Switzerland. Hospitalised adult surgical patients who received anaesthesia and stayed in the Post Anaesthesia Care Unit - Intermediate Care Unit (PACU-IMC) between July 2008 and June 2011 were included. Outcome measure was in-hospital 30-day mortality. Expected probabilities of in-hospital death were estimated with the surgical mortality probability model (S-MPM). Descriptive statistics were calculated. Univariate and multivariate logistic regressions (odds ratio [OR] with 95% confidence interval [95% CI]) were used to identify risk factors of mortality. Overall in-hospital mortality was 0.8% (176/24 160 patients). Observed 30-day in-hospital mortality was 0.7%; expected mortality from the S-MPM was 1.2%. Independent risk factors were age (OR 1.05, 95% CI 1.03-1.06), American Society of Anesthesiologists Physical Status score (ASA PS 3-5 vs ASA PS 1-2: OR 5.48, 95% CI 3.12-9.63), nonelective surgery (vs elective surgery) (OR 3.15, 95% CI 2.04-4.86), head surgery (OR 2.83, 95% CI 1.41-5.67) and duration of PACU-IMC stay (OR 1.00, 95% CI 1.00-1.00). A protective factor was a high body mass index (OR 0.92, 95% CI 0.89-0.96). The procedural risk, type and time of anaesthesia and day of intervention were not independent risk factors of mortality. The postoperative observed-to-expected mortality ratio was favourable. Independent postoperative risk factors for mortality were well-established factors such as age, ASA PS, non elective surgery but also duration of PACU-IMC stay which was considered as a surrogate of postoperative complications.
Highlights
Postinterventional in-hospital death in cardiac or noncardiac surgery and interventional medicine is a reality, even in high-quality hospitals, and is frequently inadequately anticipated
Independent risk factors were age, American Society of Anesthesiologists Physical Status score (ASA PS 3–5 vs ASA PS 1-2: odds ratio (OR) 5.48, 95% confidence interval (95% CI) 3.12–9.63), nonelective surgery, head surgery and duration of PACU-intermediate care unit (IMC) stay
Body mass index, types of surgery, type of anaesthesia, weekend intervention, anaesthesia time, and PACU-IMC stay duration as possible further independent risk factors for postoperative mortality
Summary
Postinterventional in-hospital death in cardiac or noncardiac surgery and interventional medicine is a reality, even in high-quality hospitals, and is frequently inadequately anticipated. Postinterventional mortality is considered as a quality and safety indicator for anaesthesia, and surgical and nonsurgical interventions. In the Netherlands, based on a population-based study involving 3.7 million surgical procedures including adults with elective, open, surgical procedures from 1991 to 2005, the 30-day death rate was 1.9% [1]. The first 48 hours after surgery were identified as the critical period in high-risk patients with the highest mortality rate and, a stay in the intensive care unit (ICU) or intermediate care unit (IMC) during this period should be considered [10]. Background/ rationale Objectives Methods Study design Setting Participants Item No Variables
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