title: Predictive risk model of 30-day mortality in plastic and reconstructive surgery patients.
abstract: BACKGROUND
  Death following surgical procedures, although uncommon, represents the most significant and costly postoperative complication. The authors delineate several key independently associated risk factors for 30-day mortality in a large nationwide plastic surgery population and generate a simple risk-assessment tool.
  
  
  METHODS
  Patients who underwent a primary plastic surgery procedure (n=24,778) were identified from the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program databases. Preoperative patient comorbidities and operative variables were analyzed to determine associations with mortality. Multivariate regression modeling and risk stratification were performed to generate a decision-support tool capable of assessing mortality risk.
  
  
  RESULTS
  Seventy-eight patients (0.31 percent) experienced 30-day mortality. Age older than 65 years, inpatient surgery, hepatorenal disease, recent chemotherapy, and partial or dependent functional status were perioperative factors associated with 30-day mortality. A composite mortality risk score was used to stratify patients into groups of low (n=18,063) (30-day mortality, 0.06 percent), intermediate (n=1252) (30-day mortality, 0.96 percent), high (n=314) (30-day mortality, 5.10 percent), or extreme (n=126) (30-day mortality, 17.46 percent) risk. The scoring groups accurately separated risk (p<0.001) with a 291-fold variation between low- and extreme-risk patients (C statistic, 0.93).
  
  
  CONCLUSIONS
  This study defines a 0.31 percent risk of perioperative 30-day mortality in a heterogeneous cohort of plastic surgery patients and identifies risk factors independently associated with 30-day mortality. These data can be used to tailor and improve informed consent, to optimize surgical decision-making, and to implement risk-reduction strategies in high-risk patients.
  
  
  METHODS
  Risk, III.
authors.affiliation: Philadelphia, Pa.; and New Haven, Conn. From the Division of Plastic Surgery, Department of Surgery, Hospital of the University of Pennsylvania at the Perelman School of Medicine; and the Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.forename: Charles T
authors.initials: CT
authors.lastname: Tuggle
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors