Complications and mortality in older surgical patients in Australia and New Zealand (the REASON study): a multicentre, prospective, observational study.
We conducted a prospective study of non-cardiac surgical patients aged 70 years or more in 23 hospitals in Australia and New Zealand. We studied 4158 consecutive patients of whom 2845 (68%) had pre-existing comorbidities. By day 30, 216 (5%) patients had died, and 835 (20%) suffered complications; 390 (9.4%) patients were admitted to the Intensive Care Unit. Pre-operative factors associated with mortality included: increasing age (80-89 years: OR 2.1 (95% CI 1.6-2.8), p < 0.001; 90+ years: OR 4.0 (95% CI 2.6-6.2), p < 0.001); worsening ASA physical status (ASA 3: OR 3.1 (95% CI 1.8-5.5), p < 0.001; ASA 4: OR 12.4 (95% CI 6.9-22.2), p < 0.001); a pre-operative plasma albumin < 30 g.l⁻¹ (OR: 2.5 (95% CI 1.8-3.5), p < 0.001); and non-scheduled surgery (OR 1.8 (95% CI 1.3-2.5), p < 0.001). Complications associated with mortality included: acute renal impairment (OR 3.3 (95% CI 2.1-5.0), p < 0.001); unplanned Intensive Care Unit admission (OR 3.1 (95% CI 1.9-4.9), p < 0.001); and systemic inflammation (OR 2.5 (95% CI 1.7-3.7), p < 0.001). Patient factors often had a stronger association with mortality than the type of surgery. Strategies are needed to reduce complications and mortality in older surgical patients.
Story
D A
DA
Department of Anaesthesia, Austin Health, Heidelberg, Australia. David.Story@austin.org
Leslie
K
K
Myles
P S
PS
Fink
M
M
Poustie
S J
SJ
Forbes
A
A
Yap
S
S
Beavis
V
V
Kerridge
R
R
D058186:Acute Kidney Injury / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007249:Inflammation / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012709:Serum Albumin / Q000032:analysis; D012737:Sex Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*
D012709:Serum Albumin