Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations

Magdalena Walicka,Agnieszka Tuszyńska,Edward Franek,Edward Franek,Edward Franek,Daniel Rutkowski,Monika Puzianowska‐Kuźnicka,Monika Puzianowska‐Kuźnicka,Monika Puzianowska‐Kuźnicka,Melania Brzozowska,Marcin Chlebus,Yaroslav Sanchak,Andrzej Śliwczyński

doi:10.1007/s00268-020-05841-3

Abstract

BackgroundIdentifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients.Materials and methodsThis retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission.ResultsThe overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The “weekend” effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission.ConclusionAge, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.

Highlights

The number of surgical interventions is increasing
There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death
Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units

Summary

Introduction

The number of surgical interventions is increasing. Weisser et al approximated that around 312.9 million surgical procedures occurred in 2012, equating to an increase of about one third over an 8 year period [1]. Mazzeffi et al analyzed all cardiac surgeries over an 8 year period in a single center and reported 3.4% in-hospital mortality rate [2]. Pucciarelli et al assessed in-hospital mortality in patients who underwent surgical procedures for colorectal cancer, based on data derived from the National Italian Hospital Discharge Dataset [3]. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. Materials and methods This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission

Methods

Results

Discussion

Conclusion