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JAMA Surg. 2013 Jan;148(1):14-21. doi: 10.1001/jamasurg.2013.671.

Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP.

Author information

1
Department of General Surgery, Stanford University, Palo Alto, California, USA.

Abstract

OBJECTIVES:

To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR).

DESIGN:

Retrospective cohort study.

SETTING:

American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2010.

MAIN OUTCOME MEASURES:

Incidence of CPR, complications, mortality, and survival to hospital discharge at 30 days or less after surgery.

RESULTS:

A total of 6382 nontrauma patients (mean age, 68 years) underwent CPR; 85.9% of events occurred postoperatively, of which 49.8% occurred within 5 days after surgery. Overall incidence of CPR was 1 in 203 surgical cases but varied by specialty (1 in 33 for cardiac surgery vs 1 in 258 for general surgery). The mortality rates varied by specialty (45.0%-74.5%) and were associated with comorbidity burden (58.7% for no comorbidity, 63.1% for 1 comorbidity, and 72.8% for ≥2 comorbidities; P < .001). A total of 77.6% of CPR patients experienced a complication; approximately 75.0% occurred before or on the day of CPR, and septicemia (26.7%), ventilator dependence (22.1%), significant bleeding (13.9%), and renal impairment (11.9%) were the most common. The overall 30-day mortality was 71.6%. Survival to discharge in 30 postoperative days or less was 19.2%; 9.2% of CPR patients were alive but hospitalized at postoperative day 30. Older age, a preexisting do-not-resuscitate order, renal impairment, disseminated cancer, preoperative sepsis, and postoperative arrest were among the factors independently associated with worse survival.

CONCLUSIONS:

One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients.

PMID:
23324834
DOI:
10.1001/jamasurg.2013.671
[Indexed for MEDLINE]

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