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J Anesth. 2018 Feb;32(1):112-119. doi: 10.1007/s00540-017-2440-1. Epub 2017 Dec 26.

Postoperative mortality and morbidity following non-cardiac surgery in a healthy patient population.

Author information

1
Department of Anesthesiology, University of California, San Diego, 200 West Arbor Dr, San Diego, CA, 92103, USA. ragabriel@ucsd.edu.
2
Department of Biomedical Informatics, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, CA, 92093-0881, USA. ragabriel@ucsd.edu.
3
Department of Anesthesiology, University of California, San Diego, 200 West Arbor Dr, San Diego, CA, 92103, USA.

Abstract

PURPOSE:

Perioperative mortality ranges from 0.4% to as high as nearly 12%. Currently, there are no large-scale studies looking specifically at the healthy surgical population alone. The primary objective of this study was to report 30-day mortality and morbidity in healthy patients and define any risk factors.

METHODS:

Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset, all patients assigned an American Society of Anesthesiologists physical status (ASA PS) classification score of 1 or 2 were included. Further patients were excluded if they had a comorbidity or underwent a procedure not likely to classify them as ASA PS 1 or 2. Multivariable logistic regression was performed to identify predictors of the outcomes, in which odds ratios (OR) and 95% confidence intervals (95% CI) were reported.

RESULTS:

There were 687,552 healthy patients included in the final analysis. Following surgery, 0.7, 7.0, and 0.7 per 1000 persons experienced 30-day mortality, sepsis, and stroke or myocardial infarction, respectively. Healthy patients greater than 80 years of age had the highest odds for mortality (OR 17.7, 95% CI 12.4-25.1, p < 0.001). Case duration was associated with increased mortality, especially in cases greater than or equal to 6 h (OR 3.0, 95% CI 2.0-4.5, p < 0.001).

CONCLUSIONS:

Thirty-day mortality and morbidity is, as expected, lower in the healthy surgical population. Age may be an indication to further risk stratify patients that are ASA PS 1 or 2 to better reflect perioperative risk.

KEYWORDS:

ASA PS Classification Score; Morbidity; Mortality; Outcomes; Surgery

PMID:
29279996
DOI:
10.1007/s00540-017-2440-1
[Indexed for MEDLINE]

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