title: Death within 48 h--adverse events after general surgical procedures.
abstract: BACKGROUND
  Comorbidity and emergency intervention are established risk factors for post-operative mortality. This study sought to identify adverse events associated with death within 48 h of general surgical procedures.
  
  
  METHODS
  All general surgical patients who died within 48 h of operative intervention from 2002-2006 in Scotland underwent retrospective peer review using established Scottish Audit of Surgical Mortality (SASM) methodologies (www.SASM.org).
  
  
  RESULTS
  During the 5 years, 1299 patients died within 48 h of surgery, 1134 (87.3%) admitted as an emergency, with a mean age of 71 years; 898 patients (69.1%) were ASA grade 3, 4 or 5; 727 (56.0%) patients had cardiovascular, 398 (30.6%) respiratory and 191 (14.7%) renal comorbidity. Over time exploratory laparotomy (443, 34.1%) was carried out less often (p = 0.004) prior to death due to cardiovascular disease (435, 33.5%), mesenteric ischaemia (264, 20.3%) or multi-organ failure (255, 19.6%). The decision to operate by consultant surgeons rose significantly (p < 0.001). Adverse events were identified in 721 of the 1299 cases; concerns about inappropriate operations (p = 0.018) and poor pre-operative assessment (p = 0.012) decreased significantly.
  
  
  CONCLUSIONS
  Patients dying within 48 h of surgery are usually elderly, emergency admissions with significant comorbidities who die of cardiovascular events. Timely, appropriate surgery and high quality peri-operative care delivered by consultant staff may prevent early post-operative mortality.
authors.affiliation: Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. russmullen@doctors.org.uk
authors.forename: Russell
authors.initials: R
authors.lastname: Mullen
authors.forename: John M
authors.initials: JM
authors.lastname: Scollay
authors.forename: Garry
authors.initials: G
authors.lastname: Hecht
authors.forename: Gillian
authors.initials: G
authors.lastname: McPhillips
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012606:Scotland; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000706:statistics & numerical data; D055815:Young Adult