title: Factors associated with unanticipated day of surgery deaths in Department of Veterans Affairs hospitals.
abstract: BACKGROUND
  Patients of ASA physical status 1, 2, and 3 undergoing elective surgery do not have underlying conditions that are a constant threat to life, and hence should not be expected to be at significant risk for death on the day of surgery.
  
  
  METHODS
  We analyzed 815,077 ASA physical status 1, 2, and 3 elective surgery patients in the Department of Veterans Affairs National Surgical Quality Improvement Program database to identify patients who died on the day of surgery. We then attempted to identify factors predictive of unexpected death and to identify potential areas for improvement in care. A subset of the cases underwent individual chart review as well to identify areas for improvement in anesthesia care.
  
  
  RESULTS
  Of the total patients, 0.08% died on the day of surgery. The strongest predictive factor by multiple variable regression was the type of surgery, with aortic surgery resulting in an odds ratio of 13.67, (95% CI 9.76-19.17). Other factors predictive of death were identified by multiple variable regressions and included low albumin, existence of dyspnea, and elevated bilirubin or creatinine. Chart reviews of 88 of the deaths found that opportunities for improved anesthesia care were present in 13 of the 88. We estimated that a death that might have been prevented by improved anesthesia care occurred in approximately 1/13,900 cases. Myocardial infarction and hemorrhage were frequently identified factors. An unexpected factor was that the period between the conclusion of surgery and the final transfer of care in recovery was a time when many of the deaths occurred.
  
  
  CONCLUSIONS
  We conclude that, although patient and surgical factors lead to the vast majority of deaths on the day of surgery, there are identifiable areas for reducing the incidence of such deaths by improvements in anesthesia care.
authors.affiliation: Department of Veterans Affairs Central Office Anesthesia Service, Washington, DC, USA. michael. bishop@va.gov
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bishop
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Souders
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Peterson
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.forename: Karen B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D005260:Female; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D013503:Surgery Department, Hospital / Q000592:standards; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014481:United States; D014493:United States Department of Veterans Affairs