Abstract
Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator, have been devised to predict postoperative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery. Data from the ACS NSQIP® database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient-related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome. A total of 5254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI: 16.75 [2.29, 122.69]), poor preoperative functional health status (odds ratio and 95%CI: 38.52 [2.46, 604.12]), and low serum albumin (odds ratio and 95%CI: 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality. In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.
Highlights
Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator have been devised to predict postoperative mortality
Relevant patient related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality
In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between American Society of Anesthesiologists (ASA) physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery
Summary
Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator have been devised to predict postoperative mortality. The database is comprised of de-identified patient information and tracks surgical outcomes with the goal of providing feedback to participating institutions.[4] The database contains preoperative and intraoperative variables which have been used to devise a surgical risk calculator (SRC).(5) The SRC has shown mixed results in predicting postoperative complications in different surgical populations[6, 7] and this discordance could, in part, be due to varying effect of the included predictors The aim of this retrospective cohort study is to identify the role of individual contributors of the ACS NSQIP® SRC in impacting postoperative mortality in patients undergoing a wide array of non-cardiac surgical procedures
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