Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) Database to Identify Factors Associated with Postoperative Mortality After Elective Non-cardiac Surgery

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.