title: Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP.
abstract: OBJECTIVE
  To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2010.
  
  
  METHODS
  Incidence of CPR, complications, mortality, and survival to hospital discharge at 30 days or less after surgery.
  
  
  RESULTS
  A total of 6382 nontrauma patients (mean age, 68 years) underwent CPR; 85.9% of events occurred postoperatively, of which 49.8% occurred within 5 days after surgery. Overall incidence of CPR was 1 in 203 surgical cases but varied by specialty (1 in 33 for cardiac surgery vs 1 in 258 for general surgery). The mortality rates varied by specialty (45.0%-74.5%) and were associated with comorbidity burden (58.7% for no comorbidity, 63.1% for 1 comorbidity, and 72.8% for ≥2 comorbidities; P < .001). A total of 77.6% of CPR patients experienced a complication; approximately 75.0% occurred before or on the day of CPR, and septicemia (26.7%), ventilator dependence (22.1%), significant bleeding (13.9%), and renal impairment (11.9%) were the most common. The overall 30-day mortality was 71.6%. Survival to discharge in 30 postoperative days or less was 19.2%; 9.2% of CPR patients were alive but hospitalized at postoperative day 30. Older age, a preexisting do-not-resuscitate order, renal impairment, disseminated cancer, preoperative sepsis, and postoperative arrest were among the factors independently associated with worse survival.
  
  
  CONCLUSIONS
  One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients.
authors: Department of General Surgery, Stanford University, Palo Alto, California, USA.
authors: Hadiza S
authors: HS
authors: Kazaure
authors: Sanziana A
authors: SA
authors: Roman
authors: Ronnie A
authors: RA
authors: Rosenthal
authors: Julie A
authors: JA
authors: Sosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult