Advertisement

Journal of Gastrointestinal Surgery

, Volume 11, Issue 7, pp 903–910 | Cite as

Risk Factors for Mortality and Postoperative Complications After Gastrointestinal Surgery

  • Lars Tue Sørensen
  • Afshin Malaki
  • Peer Wille-Jørgensen
  • Finn Kallehave
  • Johan Kjærgaard
  • Ulla Hemmingsen
  • Lisbeth Nørgaard Møller
  • Torben Jørgensen
Article

Abstract

Background

Predictors of a poor surgical outcome are numerous, of which some are well-defined. We aimed to assess risk factors predictive of poor surgical outcome across different gastrointestinal operations related to the patient, the disease, the treatment, and the organization of care.

Methods

Data from 5,255 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 was prospectively recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and complexity, and the surgeon’s training. Variables predictive of mortality and complications occurring within 30 days after surgery were assessed by multiple logistic regression analysis.

Results

After elective operation, the 30-day mortality was 2.8% and major complications occurred in 11.5% of the patients. The corresponding figures in emergency surgery were 13.8% and 30.1%. Independent of elective or emergency surgery, dependent functional status, and type of operation were associated with postoperative mortality. Comorbidity, type of operation, blood loss, and reoperation were predictors of complications regardless of elective or emergency operation. In elective surgery, predictors of poor surgical outcome were high age, comorbidity, malignancy, and the surgeons training, whereas abnormal vital signs values and peritonitis were predictors of poor outcome after emergency surgery.

Conclusion

Premorbid factors, characteristics of the disease, the patients’ preoperative condition, operative factors, and the surgeon’s training are all associated with surgical outcome across different gastrointestinal operations and should be assessed when auditing surgical outcome.

Keywords

Risk factors Mortality Postoperative complications General surgery Gastrointestinal surgery 

Notes

Acknowledgments

The study received financial support from the Danish National Board of Health. The authors wish to thank S. Meisner and the surgical staff of the department for collecting the data.

Reference

  1. 1.
    Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF. Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 2000;43:83–91.PubMedCrossRefGoogle Scholar
  2. 2.
    Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon’s training, certification, and experience. Surgery 2002;132:663–670.PubMedCrossRefGoogle Scholar
  3. 3.
    Bender JS, Bouwman DL. Total abdominal colectomy: conditions defining outcome. Am Surgeon 1994;60:205–209.PubMedGoogle Scholar
  4. 4.
    Sasako M. Risk factors for surgical treatment in the Dutch Gastric Cancer Trial. Br J Surg 1997;84:1567–1571.PubMedCrossRefGoogle Scholar
  5. 5.
    Daley J, Khuri SF, Henderson W, Hur K, Gibbs JO, Barbour G, Demakis J, Irvin G, III, Stremple JF, Grover F, McDonald G, Passaro E, Jr., Fabri PJ, Spencer J, Hammermeister K, Aust JB, Oprian C. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997;185:328–340.PubMedGoogle Scholar
  6. 6.
    Wille-Jorgensen PA, Sorensen LT, Roodpashti AM, Jorgensen T, Meisner S. Difficulties with implementation and maintenance of a clinical database [English abstract]. Ugeskr Laeger 1999;161: 6359–6362.PubMedGoogle Scholar
  7. 7.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991;78:355–360.PubMedCrossRefGoogle Scholar
  8. 8.
    Sagar PM, Hartley MN, Mancey-Jones B, Sedman PC, May J, Macfie J. Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg 1994;81:1492–1494.PubMedCrossRefGoogle Scholar
  9. 9.
    Sackett DL, Haynes RB, Goyatt GH, Tugwell P. Clinical Epidemiology. A Basic Science for Clinical Medicine. Boston, USA: Little & Brown, 1991.Google Scholar
  10. 10.
    Hadjianastassiou VG, Tekkis PP, Poloniecki JD, Gavalas MC, Goldhill DR. Surgical mortality score: risk management tool for auditing surgical performance. World J Surg 2004;28:193–200.PubMedCrossRefGoogle Scholar
  11. 11.
    Arenal JJ, Benito C, Concejo MP, Ortega E. Colorectal resection and primary anastomosis in patients aged 70 and older: prospective study. Eur J Surg 1999;165:593–597.PubMedCrossRefGoogle Scholar
  12. 12.
    Fallahzadeh H, Mays ET. Preexisting disease as a predictor of the outcome of colectomy. Am J Surg 1991;162:497–498.PubMedCrossRefGoogle Scholar
  13. 13.
    Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 1997;12:203–208.PubMedGoogle Scholar
  14. 14.
    Torralba JA, Robles R, Parrilla P, Lujan JA, Liron R, Pinero A, Fernandez JA. Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum 1998;41:18–22.PubMedCrossRefGoogle Scholar
  15. 15.
    Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 2000;87:467–471.CrossRefGoogle Scholar
  16. 16.
    Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, Kizer KW, Aust JB, Bell RH, Jr., Chong V, Demakis J, Fabri PJ, Gibbs JO, Grover F, Hammermeister K et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999;230:414–429.PubMedCrossRefGoogle Scholar
  17. 17.
    Ghorra SG, Rzeczycki TP, Natarajan R, Pricolo VE. Colostomy closure: impact of preoperative risk factors on morbidity. Am Surgeon 1999;65:266–269.PubMedGoogle Scholar
  18. 18.
    Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 2000;179: 275–281.PubMedCrossRefGoogle Scholar
  19. 19.
    Biondo S, Ramos E, Deiros M, Rague JM, De Oca J, Moreno P, Farran L, Jaurrieta E. Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg 2000;191:635–642.PubMedCrossRefGoogle Scholar
  20. 20.
    Rosen AK, Ash AS, McNiff KJ, Moskowitz MA. The importance of severity of illness adjustment in predicting adverse outcomes in the Medicare population. J Clin Epidemiol 1995;48:631–643.PubMedCrossRefGoogle Scholar
  21. 21.
    Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000;179:92–96.PubMedCrossRefGoogle Scholar
  22. 22.
    Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg 1999;134:935–938.PubMedCrossRefGoogle Scholar
  23. 23.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355–358.PubMedCrossRefGoogle Scholar
  24. 24.
    Bulow S, Moesgaard FA, Billesbolle P, Harling H, Holm J, Madsen MR, Myrhoj T, Nymann T, Okholm M, Qvist N, Riber C. Anastomotic leakage after low anterior resection for rectal cancer [English abstract]. Ugeskr Laeger 1997;159:297–301.PubMedGoogle Scholar
  25. 25.
    Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002;26:499–502.PubMedCrossRefGoogle Scholar
  26. 26.
    Yasuda K, Shiraishi N, Adachi Y, Inomata M, Sato K, Kitano S. Risk factors for complications following resection of large gastric cancer. Br J Surg 2001;88:873–877.PubMedCrossRefGoogle Scholar
  27. 27.
    Israelsson LA. The surgeon as a risk factor for complications of midline incisions. Eur J Surg 1998; 164:353–359.PubMedCrossRefGoogle Scholar
  28. 28.
    Gislason H, Soreide O, Viste A. Wound complications after major gastrointestinal operations. The surgeon as a risk factor. Dig Surg 1999;16:512–514.PubMedCrossRefGoogle Scholar
  29. 29.
    Wille-Jorgensen PA, Meisner S. The validity of data in registration of operations. A quality analysis [English abstract]. Ugeskr Laeger 1997;159:7328–7330.PubMedGoogle Scholar
  30. 30.
    Tonnesen H. Alcohol abuse and postoperative morbidity. Dan Med Bull 2003;50:139–160.PubMedGoogle Scholar
  31. 31.
    Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 1999;86:927–931.PubMedCrossRefGoogle Scholar
  32. 32.
    Myles PS, Iacono GA, Hunt JO, Fletcher H, Morris J, McIlroy D, Fritschi L. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers. Anesthesiology 2002;97:842–847.PubMedCrossRefGoogle Scholar
  33. 33.
    Sorensen LT, Horby J, Friis E, Pilsgaard B, Jorgensen T. Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 2002;28:815–820.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Lars Tue Sørensen
    • 1
  • Afshin Malaki
    • 1
  • Peer Wille-Jørgensen
    • 1
  • Finn Kallehave
    • 1
  • Johan Kjærgaard
    • 1
  • Ulla Hemmingsen
    • 1
  • Lisbeth Nørgaard Møller
    • 2
  • Torben Jørgensen
    • 2
  1. 1.Department of Surgical GastroenterologyBispebjerg HospitalCopenhagenDenmark
  2. 2.Research Centre for Prevention and HealthGlostrup Hospital, University of CopenhagenCopenhagenDenmark

Personalised recommendations