Abstract
BackgroundThe rapidly aging population affects Japan’s health system, which is characterized by equity and full health insurance coverage for the entire population. However, the current outcomes after surgery in tertiary hospitals in Japan are not known. We aimed to gain an overview of postoperative mortality and death in a tertiary university hospital.MethodsUsing the administrative database of Kawasaki Medical School Hospital, we investigated the pattern of in-hospital mortality and death for patients who underwent surgery under general or regional anesthesia between January 2010 and December 2011. We used a logistic regression model to find pre-operative risk factors associated with in-hospital mortality in this derivation cohort and tested its results in the validation cohort obtained from surgical patients between January 2012 and April 2014.ResultsAmong 8414 admissions for surgery patients aged ≥65 years was 41.0 %, reflecting aged population in Japan. There were 170 deaths in the derivation cohort, resulting in in-hospital mortality of 2.0 %, and in 30-day mortality of 1.0 %, because a half of the death occurred later than 30 days. We identified four independent preoperative risk factors for in-hospital mortality: high-risk surgery [odds ratio (OR) 18.64], moderate-risk surgery (OR 5.00), ASA-PS ≥3 (OR 5.55), and emergency (OR 2.35). A good correlation between actual and calculated mortality based on the derivation cohort was confirmed in the validation cohort.ConclusionsThis retrospective study of a single university hospital in Japan shows that aged patients in their 70 s is the largest group undergoing surgery, and that the overall in-hospital mortality is similar to that of other countries, but the 30-day mortality is less than that. Risk stratification for in-hospital mortality using preoperative factors was validated.
Highlights
The rapidly aging population affects Japan’s health system, which is characterized by equity and full health insurance coverage for the entire population
Surgical patients During the period between January 2010 and April 2014, a total of 19,190 cases of inpatient surgery/anesthesia were performed in 15,260 patients at Kawasaki Medical School Hospital
The hospital data based on the first surgery during each hospital admission was divided into the derivation cohort consisting of 8414 anesthesia/surgery cases with 170 cases of in-hospital mortality, and the validation cohort of 9311 anesthesia/ surgery cases with 139 cases of in-hospital mortality (Fig. 1)
Summary
The rapidly aging population affects Japan’s health system, which is characterized by equity and full health insurance coverage for the entire population. The current outcomes after surgery in tertiary hospitals in Japan are not known. We aimed to gain an overview of postoperative mortality and death in a tertiary university hospital. The number of elderly patients undergoing surgery has rapidly increased in Japan, which has one of the longest life expectancies in the world (Reich and Shibuya 2015). Advances in surgical and anesthetic technique and improved peri-operative care are thought to have contributed to the decline (Bainbridge et al 2012). We do not have a clear idea of the outcome of current surgical procedures, especially in a tertiary hospital in Japan (Reich and Shibuya 2015). We aimed to gain an overview of recent surgical outcomes based on the mortality rate, its pre-operative risk factors, and the pattern of death using the administrative database of a tertiary university hospital
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