NESS - Timing of Perioperative Mortality by Cause of Death in a General Surgery Cohort: A One-Year Review of 10,807 Consecutive Patients

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Timing of Perioperative Mortality by Cause of Death in a General Surgery Cohort: A One-Year Review of 10,807 Consecutive Patients
*Breanna Y. Jedrzejewski, *Patrick M. Mulvaney, *Brian C. Drolet, William G. Cioffi, Thomas J. Miner
The Warren Alpert Medical School of Brown University, Providence, RI

Objective
To examine and characterize perioperative mortality according to cause, timing of death, and surgical acuity
Design
Retrospective chart review of 10,807 consecutive surgical patients (17,815 procedures) from January 1-December 31, 2011
Setting
Academic Medical Center
Patients
All patients who underwent a surgical procedure between the listed dates were reviewed. Patients who died within 30 days of operation were included for analysis.
Interventions
None
Main Outcome Measures
Independent-Samples Mann-Whitney Test was used to determine significant differences in the median time from last surgical procedure to death among various demographic groups.
Results
Procedural mortality rate was 0.99% (177 deaths among 17,815 procedures) and overall mortality was 1.64% for all patients in the study. Patients with primary oncologic diagnoses accounted for 20.3% (N=36) of perioperative deaths. Of this subset, 69.4% (25/36) died following an elective procedure. Nearly half of cancer patients (17/36; 47.2%) died in the hospital without hospice care. Patients who died from disease progression lived longer than those who died from surgical complications (p=0.005) or trauma (p=0.000). No significant differences were found in time from last procedure to death when comparing mortalities from disease progression to “other” causes (p=0.418).
Conclusions
Patients with surgical complications were found to die sooner than those with disease progression. In addition, we found that a significant portion of cancer-related, surgical mortality occurred following elective procedures. This suggests higher risk in this population, even for non-emergent cases. The recognition of complications as a contributor to mortality is vital in the preoperative counseling of patients.
Type of death Median time from procedure to death (in days) Total no. of deaths per type Elective Urgent Emergent
Trauma 1 48 6 (12.5%) 4 (8.3%) 38(79%)
Surgical complications 4 15 9 (59%) 3 (24%) 3 (18%)
Other* 9 55 21(38%) 19(35%) 15(27%)
Disease progression 12 59 34 (58%) 13(21%) 12(21%)
*Other: cardiorespiratory arrest, stroke, and sepsis not recorded as complication to surgery.

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