Factors associated with posoperative mortality in high perioperative risk patients. Cohort study
Introduction: Determining perioperative risk is part of the strategies implemented with the aim of reducing morbidity and mortality in the surgical population in the world. Although there is no established definition, high perioperative risk is associated with the group of patients with the highest disease burden.
Objective: To determine postoperative mortality and its associated factors in patients with high perioperative risk.
Methods: Analytical observational cohort study of high perioperative risk patients included in the database (n = 843) of the anesthesia program in a high complexity hospital in Colombia, between January 2011 and April 2018. Pre and postoperative variables were analyzed using uni and multivariate logistic regression per protocol. Overall and stratified mortality were estimated and factors associated with their occurrence were analyzed. Finally, survival was analyzed, the primary outcome being overall cohort mortality and stratified high cardiovascular risk mortality.
Results: Cumulative 7-day mortality was 3.68% (95% CI 2.40-4.95%) and 30-day mortality was 10.08% (95% CI 8.05-12.12%). Perioperative mortality in the high cardiovascular risk group in the first 7 days was 3.60% (95% CI 1.13-6.07%) and 14.86% (95% CI 10.15-19.58%) at 30 days. The following preoperative variables were associated with mortality: chronic obstructive pulmonary disease, chronic kidney disease, limited functional class and abdominal aortic aneurysm. A strong association was observed between postoperative complications and a significant increase in mortality rate; the most relevant complications were cerebrovascular events and cardiogenic shock.
Conclusions: In this group of high perioperative risk patients, and in the subgroup of high cardiovascular risk patients, overall mortality at 7 and at 30 days was estimated to be above values reported in various countries. Mortality was significantly increased by the presence of preoperative factors and postoperative complications.
Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522-38. doi: http://doi.org/10.1097/ALN.0b013e31823c1067.
Boyd O, Jackson N. How is risk defined in high-risk surgical patient management? Crit Care. 2005;9(4):390-6. doi: http://doi.org/10.1186/cc3057.
Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006;10(3):R81. doi: http://doi.org/10.1186/cc4928.
Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011;55(2):111-5. doi: http://doi.org/10.4103/0019-5049.79879.
Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med. 2010;152(1):26-35. doi: http://doi.org/10.7326/0003-4819-152-1-201001050-00007.
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78(3):355-60. doi: http://doi.org/10.1002/bjs.1800780327.
Lam CM, Fan ST, Yuen AW, Law WL, Poon K. Validation of POSSUM scoring systems for audit of major hepatectomy. Br J Surg. 2004;91(4):450-4. doi: http://doi.org/10.1002/bjs.4515.
Mohil RS, Bhatnagar D, Bahadur L, Rajneesh, Dev DK, Magan M. POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Br J Surg. 2004;91(4):500-3. doi: http://doi.org/10.1002/bjs.4465.
Tez M, Yoldaş O, Gocmen E, Külah B, Koc M. Evaluation of P-POSSUM and CR-POSSUM scores in patients with colorectal cancer undergoing resection. World J Surg. 2006;30(12):2266-9. doi: http://doi.org/10.1007/s00268-005-0675-8.
van Zeeland ML, Genovesi IP, Mulder JW, Strating PR, Glas AS, Engel AF. POSSUM predicts hospital mortality and long-term survival in patients with hip fractures. J Trauma. 2011;70(4):E67-72. doi: http://doi.org/10.1097/TA.0b013e3181edbf7a.
Oliveros Rodríguez H, Martínez Pacheco F, Lobelo García R, Santrich D. Factores de riesgo determinantes de mortalidad postoperatoria en UCI, en los pacientes quirúrgicos de alto riesgo. Colombian Journal of Anesthesiology . 2005;33(1):17-23.
Mena Méndez Y, Pérez Cely JA, Oliveros Rodríguez H. Protocolo de investigación - Factores de riesgo de mortalidad post-operatoria intrahospitalaria en pacientes de alto riesgo perioperatorio en un hospital de tercer nivel [internet]. 2013. [Cited 28 Jun 2022]. Available at: https://intellectum.unisabana.edu.co/bitstream/handle/10818/9502/Yonny %20Mena%20M%C3%A9ndez.%20tesis.pdf?sequence=1&isAllowed=y
Watters DA, Hollands MJ, Gruen RL, Maoate K, Perndt H, McDougall RJ, et al. Perioperative mortality rate (POMR): a global indicator of access to safe surgery and anaesthesia. World J Surg. 2015;39(4):856-64. doi: http://doi.org/10.1007/s00268-014-2638-4.
Pollard RJ, Hopkins T, Smith CT, May BV, Doyle J, Chambers CL, et al. Perianesthetic and anesthesia-related mortality in a Southeastern United States population: A longitudinal review of a prospectively collected quality assurance data base. Anesth Analg. 2018;127(3):730-735. doi: http://doi.org/10.1213/ANE.0000000000003483.
Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012;380(9847):1059-65. doi: http://doi.org/10.1016/S0140-6736(12)61148-9.
Pignaton W, Braz JRC, Kusano PS, Módolo MP, de Carvalho LR, Braz MG, et al. Perioperative and anesthesia-related mortality: An 8-year observational survey from a tertiary teaching hospital. Medicine (Baltimore). 2016;95(2):e2208. doi: http://doi.org/10.1097/MD.0000000000002208.
Lienhart A, Auroy Y, Péquignot F, Benhamou D, Warszawski J, Bovet M, et al. Survey of anesthesia-related mortality in France. Anesthesiology. 2006;105(6):1087-97. doi: http://doi.org/10.1097/00000542-200612000-00008.
Koo CY, Hyder JA, Wanderer JP, Eikermann M, Ramachandran SK. A meta-analysis of the predictive accuracy of postoperative mortality using the American Society of Anesthesiologists' physical status classification system. World J Surg. 2015;39(1):88-103. doi: http://doi.org/10.1007/s00268-014-2783-9.
Sigakis MJ, Bittner EA, Wanderer JP. Validation of a risk stratification index and risk quantification index for predicting patient outcomes: in-hospital mortality, 30-day mortality, 1-year mortality, and length-of-stay. Anesthesiology. 2013;119(3):525-40. doi: http://doi.org/10.1097/ALN.0b013e31829ce6e6.
Whitlock EL, Feiner JR, Chen LL. Perioperative mortality, 2010 to 2014: A Retrospective cohort study using the National Anesthesia Clinical Outcomes Registry. Anesthesiology. 2015;123(6):1312-21. doi: http://doi.org/10.1097/ALN.0000000000000882.
Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand. 1990;34(2):144-55. doi: http://doi.org/10.1111/j.1399-6576.1990.tb03059.x.
Braz LG, Braz DG, Cruz DS, Fernandes LA, Módolo NS, Braz JR. Mortality in anesthesia: a systematic review. Clinics (Sao Paulo). 2009;64(10):999-1006. doi: http://doi.org/10.1590/S1807-59322009001000011.
Jakobson T, Karjagin J, Vipp L, Padar M, Parik AH, Starkopf L, et al. Postoperative complications and mortality after major gastrointestinal surgery. Medicina (Kaunas). 2014;50(2):111-7. doi: http://doi.org/10.1016/j.medici.2014.06.002.
Romagnoli S, Ricci Z, Ronco C. Perioperative acute kidney injury: Prevention, early recognition, and supportive measures. Nephron. 2018;140(2):105-110. doi: http://doi.org/10.1159/000490500.
Larmour KE, Maxwell AP. Early intervention can improve outcomes in acute kidney injury. Practitioner. 2015;259(1783):25-8.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi: http://doi.org/10.1093/eurheartj/ehx393.
Collet JP, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-367. doi: http://doi.org/10.1093/eurheartj/ehaa575.
Copyright (c) 2022 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.
This journal uses Crossref's Cited-By and Reference Linking, so that we can display the citations registered in Crossref here.
This document does not have Crossref citations yet.