title: Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years.
abstract: This study sought to characterize in-hospital post-colectomy mortality in New York State. One hundred sixty thousand seven hundred ninety-two patients who underwent colectomy from 1995 to 2014 were analyzed from the all-payer New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear trends of in-hospital mortality rate over 20 years were calculated using log-linear regression models. Chi-square tests were used to compare categorical variables between patients. Multivariable regression models were further used to calculate risk of in-hospital mortality associated with specific demographics, co-morbidities, and perioperative complications. From 1995 to 2014, 7308 (4.5%) in-hospital mortalities occurred within 30 days of surgery. Over this time period, the rate of overall in-hospital post-colectomy mortality decreased by 3.3% (6.3 to 3%, p < 0.0001). The risk of in-hospital mortality for patients receiving emergent and elective surgery decreased by 1% (RR 0.99 [0.98-1.00], p = 0.0005) and 5% (RR 0.95 [0.94-0.96], p < 0.0001) each year, respectively. Patients who underwent open surgeries were more likely to experience in-hospital mortality (adjusted OR 3.65 [3.16-4.21], p < 0.0001), with an increased risk of in-hospital mortality each year (RR 1.01 [1.00-1.03], p = 0.0387). Numerous other risk factors were identified. In-hospital post-colectomy mortality decreased at a slower rate in emergent versus elective surgeries. The risk of in-hospital mortality has increased in open colectomies.
authors.affiliation: Stony Brook University School of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA. ryan.lamm@stonybrookmedicine.edu.
authors.forename: Ryan
authors.identifier: 0000-0002-9158-654X
authors.initials: R
authors.lastname: Lamm
authors.affiliation: Stony Brook University School of Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Mathews
authors.affiliation: Department of Family, Population and Preventative Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Jihye
authors.initials: J
authors.lastname: Park
authors.affiliation: Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
authors.forename: Aurora D
authors.initials: AD
authors.lastname: Pryor
authors.affiliation: Section of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
authors.forename: Dana
authors.initials: D
authors.lastname: Telem
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D062072:Patient Acuity; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Mortality; New York State; Post-colectomy