Advertisement

Journal of Anesthesia

, Volume 27, Issue 6, pp 838–843 | Cite as

Risk factors for postoperative mortality and morbidities in emergency surgeries

  • Tomonori Matsuyama
  • Hiroshi IranamiEmail author
  • Keisuke Fujii
  • Mariko Inoue
  • Reiko Nakagawa
  • Kohei Kawashima
Original Article

Abstract

Background

Emergency surgery itself induces high risk for postoperative mortality and morbidities; however, it remains unknown which concomitant pathological conditions of emergency surgeries are causative factors of deteriorating outcomes. This study examined the causal factors of postoperative mortality and morbidity in cases of emergency surgery.

Methods

Patients undergoing emergency surgery from January to December 2007 were enrolled in this retrospective cohort study. Causal relationships were analyzed by stepwise multivariate logistic regression analysis between possible independent factors (sex, age, kind of surgical department, timing of surgery, duration of surgery, blood transfusion, deteriorated consciousness level, shock state, abnormal coagulate state, and history of hypertension, diabetes, ischemic heart disease, chronic obstructive pulmonary disease, renal failure, and anemia) and postoperative mortality or morbidities (failure of removal of tracheal tube after operation, tracheotomy, cerebral infarction, massive hemorrhage, severe hypotension, severe hypoxemia, and severe arrhythmia during or after surgery).

Results

Shock, deteriorated consciousness level, chronic obstructive lung disease, and ischemic heart disease were significant risk factors for mortality (OR 14.2, 7.9, 6.4, and 3.8, respectively), and deteriorated consciousness level, blood transfusion, shock, chronic obstructive lung disease, diabetes, cardiovascular surgery, and operation longer than 2 h were significant risk factors for morbidity (OR 19.1, 3.3, 3.0, 2.5, 2.4, 2.4, and 1.8, respectively).

Conclusion

State of shock, deteriorated consciousness level, chronic obstructive lung disease, ischemic heart disease, hemorrhage requiring blood transfusion, age over 80 years, cardiovascular surgery, surgeries at night, and surgeries of duration more than 2 h cause patients to be strongly susceptible to postoperative mortality or morbidity in emergency surgeries.

Keywords

Emergency Morbidity Mortality Anesthesia 

Notes

Conflict of interest

None.

References

  1. 1.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Gaston MS, Amin AK, Clayton RA, Brenkel IJ. Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty? Surgeon. 2007;5:260–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Markus PM, Martell J, Leister I, Horstmann O, Brinker J, Becker H. Predicting postoperative morbidity by clinical assessment. Br J Surg. 2005;92:101–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Campillo-Soto A, Flores-Pastor B, Soria-Aledo V, Candel-Arenas M, Andrés-García B, Martín-Lorenzo JG, Aguayo-Albasini JL. The POSSUM scoring system: an instrument for measuring quality in surgical patients. Cir Esp. 2006;80:395–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Sutton R, Bann S, Brooks M, Sarin S. The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg. 2002;89:763–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Prause G, Ratzenhofer-Komenda B, Smolle-Juettner F, Krenn H, Pojer H, Toller W, Voit H, Offner A, Smolle J. Operations on patients deemed “unfit for operation and anaesthesia:” what are the consequences? Acta Anaesthesiol Scand. 1998;42:316–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Hobson SA, Sutton CD, Garcea G, Thomas WM. Prospective comparison of POSSUM and P-POSSUM with clinical assessment of mortality following emergency surgery. Acta Anaesthesiol Scand. 2007;51:94–100.PubMedCrossRefGoogle Scholar
  8. 8.
    Sørensen LT, Malaki A, Wille-Jørgensen P, Kallehave F, Kjaergaard J, Hemmingsen U, Møller LN, Jørgensen T. Risk factors for mortality and postoperative complications after gastrointestinal surgery. J Gastrointest Surg. 2007;11:903–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Chavanon O, Costache V, Bach V, Kétata A, Durand M, Hacini R, Thony F, Blin D. Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases. Interact Cardiovasc Thorac Surg. 2007;6:43–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am J Gastroenterol. 2007;102:563–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Ramachandran R, Hegde T. Chronic subdural hematomas–causes of morbidity and mortality. Surg Neurol. 2007;67:367–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Treacy PJ, Reilly P, Brophy B. Emergency neurosurgery by general surgeons at a remote major hospital. ANZ J Surg. 2005;75:852–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Tao LS, Mackenzie CR, Charlson ME. Predictors of postoperative complications in the patient with diabetes mellitus. J Diabetes Complicat. 2008;22:24–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Mohammadi S, Dagenais F, Mathieu P, Kingma JG, Doyle D, Lopez S, Baillot R, Perron J, Charbonneau E, Dumont E, Metras J, Desaulniers D, Voisine P. Long-term impact of diabetes and its comorbidities in patients undergoing isolated primary coronary artery bypass graft surgery. Circulation. 2007;116:I220–5.PubMedGoogle Scholar
  15. 15.
    Greillier L, Thomas P, Loundou A, Doddoli C, Badier M, Auquier P, Barlési F. Pulmonary function tests as a predictor of quantitative and qualitative outcomes after thoracic surgery for lung cancer. Clin Lung Cancer. 2007;8:554–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Filsoufi F, Rahmanian PB, Castillo JG, Chikwe J, Carpentier A, Adams DH. Early and late outcomes of cardiac surgery in patients with moderate to severe preoperative renal dysfunction without dialysis. Interact Cardiovasc Thorac Surg. 2008;7:90–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Scott BH, Seifert FC, Grimson R. Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery. Ann Card Anaesth. 2008;11:15–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Dionigi G, Rovera F, Boni L, Carrafiello G, Recaldini C, Mangini M, Laganà D, Bacuzzi A, Dionigi R. The impact of perioperative blood transfusion on clinical outcomes in colorectal surgery. Surg Oncol. 2007;16:S177–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg. 2000;87:1553–62.PubMedCrossRefGoogle Scholar
  20. 20.
    Hirzalla O, Emous M, Ubbink DT, Legemate D. External validation of the Glasgow Aneurysm Score to predict outcome in elective open abdominal aortic aneurysm repair. J Vasc Surg. 2006;44:712–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Kocer B, Surmeli S, Solak C, Unal B, Bozkurt B, Yildirim O, Dolapci M, Cengiz O. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol. 2007;22:565–70.PubMedCrossRefGoogle Scholar
  22. 22.
    Silberman S, Oren A, Klutstein MW, Merin O, Fink D, Bitran D. Surgery for ischemic mitral regurgitation: results and long-term follow-up. Harefuah. 2007;146:841–843, 911.PubMedGoogle Scholar
  23. 23.
    Açil T, Cölkesen Y, Türköz R, Sezgin AT, Baltali M, Gülcan O, Demircan S, Yildirir A, Ozin B, Müderrisoğlu H. Value of preoperative echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting. Am J Cardiol. 2007;100:1383–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Bose AK, Aitchison JD, Dark JH. Aortic valve replacement in octogenarians. J Cardiothorac Surg. 2007;2:33.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Ford PN, Thomas I, Cook TM, Whitley E, Peden CJ. Determinants of outcome in critically ill octogenarians after surgery: an observational study. Br J Anaesth. 2007;99:824–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Carmody IC, Romero J, Velmahos GC. Day for night: should we staff a trauma center like a nightclub? Am Surg. 2002;68:1048–51.PubMedGoogle Scholar
  27. 27.
    Luyt CE, Combes A, Aegerter P, Guidet B, Trouillet JL, Gibert C, Chastre J. Mortality among patients admitted to intensive care units during weekday day shifts compared with “off” hours. Crit Care Med. 2007;35:3–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Dimick JB, Swoboda SM, Pronovost PJ, Lipsett PA. Effect of nurse-to-patient ratio in the intensive care unit on pulmonary complications and resource use after hepatectomy. Am J Crit Care. 2001;10:376–82.PubMedGoogle Scholar
  29. 29.
    Dzankic S, Pastor D, Gonzalez C, Leung JM. The prevalence and predictive value of abnormal preoperative laboratory tests in elderly surgical patients. Anesth Analg. 2001;93:249–50.Google Scholar
  30. 30.
    Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, Dick AW. The Surgical Mortality Probability Model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg. 2012;255:696–702.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Tomonori Matsuyama
    • 1
  • Hiroshi Iranami
    • 3
    • 4
    Email author
  • Keisuke Fujii
    • 2
  • Mariko Inoue
    • 4
  • Reiko Nakagawa
    • 2
  • Kohei Kawashima
    • 5
  1. 1.Department of AnesthesiaKyoto University HospitalKyotoJapan
  2. 2.Department of AnesthesiologyJapanese Red Cross Society Wakayama Medical CenterWakayama CityJapan
  3. 3.Department of AnesthesiologyWakayama Medical UniversityWakayama CityJapan
  4. 4.Department of AnesthesiologyWakayama Rosai HospitalWakayama CityJapan
  5. 5.Department of AnesthesiologyNational Hospital Organization Minami Wakayama Medical CenterTanabe CityJapan

Personalised recommendations