Complications Associated With Mortality in the National Surgical Quality Improvement Program Database

被引:25
作者
Freundlich, Robert E. [1 ]
Maile, Michael D. [2 ]
Sferra, Joseph J. [3 ]
Jewell, Elizabeth S. [2 ]
Kheterpal, Sachin [2 ]
Engoren, Milo [2 ,4 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Anesthesiol, 1211 21st Ave S,Suite MAB 526, Nashville, TN 37212 USA
[2] Univ Michigan, Dept Anesthesiol, Ann Arbor, MI 48109 USA
[3] Univ Toledo, Coll Med & Life Sci, Dept Surg, ProMed Toledo Hosp, 2801 W Bancroft St, Toledo, OH 43606 USA
[4] ProMed Toledo Hosp, Dept Anesthesiol, Toledo, OH USA
关键词
VENTILATOR-ASSOCIATED PNEUMONIA; ACUTE KIDNEY INJURY; ATTRIBUTABLE MORTALITY; NONCARDIAC SURGERY; HOSPITAL MORTALITY; FAILURE; RESCUE; INFECTIONS; RISK; ANESTHESIA;
D O I
10.1213/ANE.0000000000002799
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Attributing causes of postoperative mortality is challenging, as death may be multifactorial. A better understanding of complications that occur in patients who die is important, as it allows clinicians to focus on the most impactful complications. We sought to determine the postoperative complications with the strongest independent association with 30-day mortality. METHODS: Data were obtained from the 2012-2013 National Surgical Quality Improvement Program Participant Use Data Files. All inpatient or admit day of surgery cases were eligible for inclusion in this study. A multivariable least absolute shrinkage and selection operator regression analysis was used to adjust for patient pre- and intraoperative risk factors for mortality. Attributable mortality was calculated using the population attributable fraction method: the ratio between the odds ratio for mortality and a given complication in the population. Patients were separated into 10 age groups to facilitate analysis of age-related differences in mortality. RESULTS: A total of 1,195,825 patients were analyzed, and 9255 deceased within 30 days (0.77%). A complication independently associated with attributable mortality was found in 1887 cases (20%). The most common causes of attributable mortality (attributable deaths per million patients) were bleeding (n = 368), respiratory failure (n = 358), septic shock (n = 170), and renal failure (n = 88). Some complications, such as urinary tract infection and pneumonia, were associated with attributable mortality only in older patients. DISCUSSION: Additional resources should be focused on complications associated with the largest attributable mortality, such as respiratory failure and infections. This is particularly important for complications disproportionately impacting younger patients, given their longer life expectancy.
引用
收藏
页码:55 / 62
页数:8
相关论文
共 40 条
  • [1] [Anonymous], 2017, BRIT J ANAESTH, V119, P553, DOI [10.1093/bja/aew316, 10.1093/bja/aew472]
  • [2] Arias E, 2018, US LIFE TABLES, DOI DOI 10.1056/NEJMP1703787
  • [3] A STUDY OF THE DEATHS ASSOCIATED WITH ANESTHESIA AND SURGERY - BASED ON A STUDY OF 599,548 ANESTHESIAS IN 10 INSTITUTIONS 1948-1952, INCLUSIVE
    BEECHER, HK
    TODD, DP
    [J]. ANNALS OF SURGERY, 1954, 140 (01) : 2 - 34
  • [4] Eliminating Central Line-Associated Bloodstream Infections: A National Patient Safety Imperative
    Berenholtz, Sean M.
    Lubomski, Lisa H.
    Weeks, Kristina
    Goeschel, Christine A.
    Marsteller, Jill A.
    Pham, Julius C.
    Sawyer, Melinda D.
    Thompson, David A.
    Winters, Bradford D.
    Cosgrove, Sara E.
    Yang, Ting
    Louis, Thomas A.
    Lucas, Barbara Meyer
    George, Christine T.
    Watson, Sam R.
    Albert-Lesher, Mariana I.
    St Andre, Justin R.
    Combes, John R.
    Bohr, Deborah
    Hines, Stephen C.
    Battles, James B.
    Pronovost, Peter J.
    [J]. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2014, 35 (01) : 56 - 62
  • [5] Do autopsies of critically ill patients reveal important findings that were clinically undetected?
    Blosser, SA
    Zimmerman, HE
    Stauffer, JL
    [J]. CRITICAL CARE MEDICINE, 1998, 26 (08) : 1332 - 1336
  • [6] The relative effect of hospital and surgeon volume on failure to rescue among patients undergoing liver resection for cancer
    Buettner, Stefan
    Gani, Faiz
    Amini, Neda
    Spolverato, Gaya
    Kim, Yuhree
    Kilic, Arman
    Wagner, Doris
    Pawlik, Timothy M.
    [J]. SURGERY, 2016, 159 (04) : 1004 - 1012
  • [7] Association of Medical Comorbidities, Surgical Outcomes, and Failure to Rescue: An Analysis of the Rhode Island Hospital NSQIP Database
    Chiulli, Larissa C.
    Stephen, Andrew H.
    Heffernan, Daithi S.
    Miner, Thomas J.
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2015, 221 (06) : 1050 - 1056
  • [8] Leaving More Than Your Fingerprint on the Intravenous Line: A Prospective Study on Propofol Anesthesia and Implications of Stopcock Contamination
    Cole, Devon C.
    Baslanti, Tezcan Ozrazgat
    Gravenstein, Nikolaus L.
    Gravenstein, Nikolaus
    [J]. ANESTHESIA AND ANALGESIA, 2015, 120 (04) : 861 - 867
  • [9] Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery
    Devereaux, P. J.
    Chan, Matthew T. V.
    Alonso-Coello, Pablo
    Walsh, Michael
    Berwanger, Otavio
    Villar, Juan Carlos
    Wang, C. Y.
    Garutti, R. Ignacio
    Jacka, Michael J.
    Sigamani, Alben
    Srinathan, Sadeesh
    Biccard, Bruce M.
    Chow, Clara K.
    Abraham, Valsa
    Tiboni, Maria
    Pettit, Shirley
    Szczeklik, Wojciech
    Buse, Giovanna Lurati
    Botto, Fernando
    Guyatt, Gordon
    Heels-Ansdell, Diane
    Sessler, Daniel I.
    Thorlund, Kristian
    Garg, Amit X.
    Mrkobrada, Marko
    Thomas, Sabu
    Rodseth, Reitze N.
    Pearse, Rupert M.
    Thabane, Lehana
    McQueen, Matthew J.
    VanHelder, Tomas
    Bhandari, Mohit
    Bosch, Jackie
    Kurz, Andrea
    Polanczyk, Carisi
    Malaga, German
    Nagele, Peter
    Le Manach, Yannick
    Leuwer, Martin
    Yusuf, Salim
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 307 (21): : 2295 - 2304
  • [10] Fecho Karamarie, 2008, Ther Clin Risk Manag, V4, P681