title: In-hospital mortality after surgery: a retrospective cohort study in a Japanese university hospital.
abstract: BACKGROUND
  The rapidly aging population affects Japan's health system, which is characterized by equity and full health insurance coverage for the entire population. However, the current outcomes after surgery in tertiary hospitals in Japan are not known. We aimed to gain an overview of postoperative mortality and death in a tertiary university hospital.
  
  
  METHODS
  Using the administrative database of Kawasaki Medical School Hospital, we investigated the pattern of in-hospital mortality and death for patients who underwent surgery under general or regional anesthesia between January 2010 and December 2011. We used a logistic regression model to find pre-operative risk factors associated with in-hospital mortality in this derivation cohort and tested its results in the validation cohort obtained from surgical patients between January 2012 and April 2014.
  
  
  RESULTS
  Among 8414 admissions for surgery patients aged ≥65 years was 41.0 %, reflecting aged population in Japan. There were 170 deaths in the derivation cohort, resulting in in-hospital mortality of 2.0 %, and in 30-day mortality of 1.0 %, because a half of the death occurred later than 30 days. We identified four independent preoperative risk factors for in-hospital mortality: high-risk surgery [odds ratio (OR) 18.64], moderate-risk surgery (OR 5.00), ASA-PS ≥3 (OR 5.55), and emergency (OR 2.35). A good correlation between actual and calculated mortality based on the derivation cohort was confirmed in the validation cohort.
  
  
  CONCLUSIONS
  This retrospective study of a single university hospital in Japan shows that aged patients in their 70 s is the largest group undergoing surgery, and that the overall in-hospital mortality is similar to that of other countries, but the 30-day mortality is less than that. Risk stratification for in-hospital mortality using preoperative factors was validated.
authors.affiliation: Department of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Shidara
authors.affiliation: Department of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan ; Department of Anesthesiology, Iwaki Kyoritsu General Hospital, 16 Kusehara, Uchigo Mimaya-machi, Iwaki, Fukushima 973-8555 Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujita
authors.affiliation: Department of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
authors.forename: Saiko
authors.initials: S
authors.lastname: Fukunaga
authors.affiliation: Department of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
authors.forename: Kae
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Uemura
keywords: Anesthesia; In-hospital mortality; Quality of care; Surgery