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. 2006 Mar;88(2):151-6.
doi: 10.1308/003588406X94896.

Identifying high-risk patients undergoing urgent and emergency surgery

W D Neary  1 , C Foy, B P Heather, J J Earnshaw
Affiliations

Identifying high-risk patients undergoing urgent and emergency surgery

W D Neary et al. Ann R Coll Surg Engl. 2006 Mar.

Abstract

Introduction: The aim was to identify high-risk patients undergoing non-elective orthopaedic and general surgery.

Patients and methods: This was a retrospective cohort study of all non-elective general and orthopaedic surgical procedures performed in a 1-year interval in a district general hospital. A total of 1869 patients underwent urgent or emergency surgery in the calendar year 2000. Outcomes were identified from various related hospital databases. Case notes of those who died were reviewed. Risk factors for mortality were examined using univariate and multivariate analysis.

Results: The mortality rates were 89/1869 (5%) at 30 days and 216 (12%) after 1 year. The high initial death rate continued for about 100 days after surgery. Increasing age (P < 0.0001), size of operation (P = 0.004) and American Society of Anesthesiologists (ASA) fitness grade (P < 0.0001) were associated with significantly higher risk of death at 1 year on multivariate analysis. A high risk group was identified of 273 patients aged over 50 years, of ASA Grade III or above who needed major surgery; they had a 30-day mortality rate of 18%.

Conclusions: A simple scoring system could be used to identify high-risk patients who require non-elective surgery that could be a target for interventions to try and reduce their risk of death.

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Figures

Figure 1
Figure 1
(a) Age profile of 857 patients who had non-elective general surgery procedures during 2000. (b) Age profile of 1012 patients who had non-elective orthopaedic surgery procedures during 2000.
Figure 1
Figure 1
(a) Age profile of 857 patients who had non-elective general surgery procedures during 2000. (b) Age profile of 1012 patients who had non-elective orthopaedic surgery procedures during 2000.
Figure 2
Figure 2
ASA distribution of patients who had non-elective general or orthopaedic surgical procedures during 2000.
Figure 3
Figure 3
Causes of death after 30 days and from 30 days to 1 year following non-elective general or orthopaedic surgery in 2000.
Figure 4
Figure 4
Date of death following non-elective general or orthopaedic surgery in 1857 patients. The mortality rate was 5% after 30 days and 12% after 1 year.
See this image and copyright information in PMC

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