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. 2020 Jan 13;20(1):11.
doi: 10.1186/s12893-019-0654-x.

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery - a retrospective cohort study

Lydia Q Liew  1 , Wei Wei Teo  2 , Edwin Seet  3 , Lyn Li Lean  1 , Ambika Paramasivan  1 , Joanna Tan  1 , Irene Lim  1 , Jiexun Wang  3 , Lian Kah Ti  1
Affiliations

Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery - a retrospective cohort study

Lydia Q Liew et al. BMC Surg. .

Abstract

Background: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery.

Methods: A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio.

Results: The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02-4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16-1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87-0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53-4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62-10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01-1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29-3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85-5.52), p < 0.001).

Conclusions: Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients' decision making and care planning.

Keywords: Anaemia; Asian; BMI; Mortality; Post-surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Van Westreenen HL, FF IJ, Wevers KP, Afzali H, Patijn GA. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum [Internet] 2011;54(11):1438–1442. doi: 10.1097/DCR.0b013e31822c64f1. - DOI - PubMed
    1. Li JL, Henderson MA, Revenig LM, Sweeney JF, Kooby DA, Maithel SK, et al. Frailty and one-year mortality in major intra-abdominal operations. J Surg Res [Internet] 2016;203(2):507–512.e1. doi: 10.1016/j.jss.2016.03.007. - DOI - PubMed
    1. Scali ST, Chang CK, Feezor RJ, Hess PJ, Beaver TM, Martin TD, et al. Preoperative prediction of mortality within 1 year after elective thoracic endovascular aortic aneurysm repair. J Vasc Surg [Internet] 2012;56(5):1266–1273. doi: 10.1016/j.jvs.2012.04.018. - DOI - PMC - PubMed
    1. Deery SE, O’Donnell TFX, Shean KE, Darling JD, Soden PA, Hughes K, et al. Racial disparities in outcomes after intact abdominal aortic aneurysm repair. J Vasc Surg [Internet] 2018;67(4):1059–1067. doi: 10.1016/j.jvs.2017.07.138. - DOI - PMC - PubMed
    1. Singapore Department of Statistics. Populatiuon Trends. 2017; Available from: http://www.singstat.gov.sg/tablebuilder.