Predictors of in-hospital mortality following non-cardiac surgery: Findings from an analysis of a South African hospital administrative database

Abstract

Background: Predictors of in-hospital mortality (IHM) following non-cardiac surgery in South African (SA) patients are not well described.

Objective: To determine the association between patient comorbidity and IHM in a cohort of SA non-cardiac surgery patients.

Methods: Data related to comorbidity and IHM for 3,727 patients aged ≥45 years were obtained from a large administrative database at a tertiary SA hospital. Logistic regression analysis was used to determine independent predictors of IHM. In addition, population-attributable fractions (PAFs) were calculated for all clinical factors identified as independent predictors of IHM.

Results: Renal dysfunction, congestive heart failure, cerebrovascular disease, male gender and high-risk surgical specialties were independently associated with IHM (odds ratios (95% confidence intervals) 7.585 (5.480-10.50); 2.604 (1.119-6.060); 2.645 (1.414-4.950); 1.433 (1.107-1.853); and 1.646 (1.213-2.233), respectively). Ischaemic heart disease, diabetes and hypertension were not identified as independent predictors of IHM in SA non-cardiac surgery patients. Renal dysfunction had the largest contribution to IHM in this study (PAF 0.34), followed by high-risk surgical specialties (PAF 0.15), male gender (PAF 0.08), cerebrovascular disease (PAF 0.03) and congestive heart failure (PAF 0.03).

Conclusion: Renal dysfunction, congestive heart failure, cerebrovascular disease, male gender and high-risk surgical specialties were major contributors to increased IHM in SA non-cardiac surgery patients. Prospectively designed research is required to determine whether ischaemic heart disease, diabetes and hypertension contribute to IHM in these patients.