title: Using predicted 30 day mortality to plan postoperative colorectal surgery care: a cohort study.
abstract: BACKGROUND
  Preoperative identification of high-risk surgical patients might help to reduce postoperative morbidity and mortality. Using a patient's predicted 30 day mortality to plan postoperative high-dependency unit (HDU) care after elective colorectal surgery might be associated with reduced postoperative morbidity.
  
  
  METHODS
  The 30 day postoperative mortality was predicted for 504 elective colorectal surgical patients in a preoperative clinic. The prediction was used to determine postoperative surgical ward or HDU care. Those with a predicted 30 day mortality of 1-3% mortality, and thus deemed at intermediate risk, had either planned HDU care (n=68) or planned ward care (n=139). The main outcome measures were emergency laparotomy and unplanned critical care admission.
  
  
  RESULTS
  There were more emergency laparotomies and unplanned critical care admissions in patients with a predicted 30 day mortality of 1-3% who went to an HDU after surgery compared with patients who went to a ward: 0 vs 14 (10%), P=0.0056 and 0 vs 22 (16%), P=0.0002, respectively.
  
  
  CONCLUSIONS
  Planned postoperative critical care was associated with a lower rate of complications after elective colorectal surgery.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Torbay Hospital, Torquay, UK michael.swart@nhs.net.
authors.forename: M
authors.initials: M
authors.lastname: Swart
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Torbay Hospital, Torquay, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Carlisle
authors.affiliation: Department of Anaesthesia, Salisbury District Hospital, Salisbury, UK.
authors.forename: J
authors.initials: J
authors.lastname: Goddard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003106:Colon / Q000601:surgery*; D003422:Critical Care; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012007:Rectum / Q000601:surgery*
keywords: cardiopulmonary exercise testing; colorectal surgery; critical care; perioperative care; risk assessment