Identifying high-risk patients undergoing urgent and emergency surgery.
BACKGROUND
The aim was to identify high-risk patients undergoing non-elective orthopaedic and general surgery.


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.
Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Gloucester, UK.
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WD
Neary
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Foy
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Heather
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Earnshaw
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004638:Emergency Treatment / Q000401:mortality*; D004739:England; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013514:Surgical Procedures, Operative / Q000401:mortality*; D013997:Time Factors