Risk factors for mortality and postoperative complications after gastrointestinal surgery.
BACKGROUND
Predictors of a poor surgical outcome are numerous, of which some are well-defined. We aimed to assess risk factors predictive of poor surgical outcome across different gastrointestinal operations related to the patient, the disease, the treatment, and the organization of care.


METHODS
Data from 5,255 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 was prospectively recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and complexity, and the surgeon's training. Variables predictive of mortality and complications occurring within 30 days after surgery were assessed by multiple logistic regression analysis.


RESULTS
After elective operation, the 30-day mortality was 2.8% and major complications occurred in 11.5% of the patients. The corresponding figures in emergency surgery were 13.8% and 30.1%. Independent of elective or emergency surgery, dependent functional status, and type of operation were associated with postoperative mortality. Comorbidity, type of operation, blood loss, and reoperation were predictors of complications regardless of elective or emergency operation. In elective surgery, predictors of poor surgical outcome were high age, comorbidity, malignancy, and the surgeons training, whereas abnormal vital signs values and peritonitis were predictors of poor outcome after emergency surgery.


CONCLUSIONS
Premorbid factors, characteristics of the disease, the patients' preoperative condition, operative factors, and the surgeon's training are all associated with surgical outcome across different gastrointestinal operations and should be assessed when auditing surgical outcome.
Sørensen
Lars Tue
LT
Department of Surgical Gastroenterology, Bispebjerg Hospital, 2400 Copenhagen, Denmark. lts@dadlnet.dk
Malaki
Afshin
A
Wille-Jørgensen
Peer
P
Kallehave
Finn
F
Kjaergaard
Johan
J
Hemmingsen
Ulla
U
Møller
Lisbeth Nørgaard
LN
Jørgensen
Torben
T
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors