Death within 48 h: adverse events after general surgical procedures

Russell Mullen, John M. Scollay, Garry Hecht, Gillian McPhillips, Alastair M. Thompson

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    17 Citations (Scopus)

    Abstract

    Background: Comorbidity and emergency intervention are established risk factors for postoperative mortality. This study sought to identify adverse events associated with death within 48 h of general surgical procedures.

    Methods: All general surgical patients who died within 48 h of operative intervention from 2002-2006 in Scotland underwent retrospective peer review using established Scottish Audit of Surgical Mortality (SASM) methodologies (www.SASM.org).

    Results: During the 5 years, 1299 patients died within 48 h of surgery, 1134 (87.3%) admitted as an emergency, with a mean age of 71 years; 898 patients (69.1%) were ASA grade 3, 4 or 5; 727 (56.0%) patients had cardiovascular, 398 (30.6%) respiratory and 191 (14.7%) renal comorbidity. Over time exploratory laparotomy (443, 34.1%) was carried out less often ( p = 0.004) prior to death due to cardiovascular disease (435, 33.5%), mesenteric ischaemia (264, 20.3%) or multi-organ failure (255, 19.6%). The decision to operate by consultant surgeons rose significantly (p < 0.001). Adverse events were identified in 721 of the 1299 cases; concerns about inappropriate operations (p = 0.018) and poor pre-operative assessment ( p = 0.012) decreased significantly.

    Conclusions: Patients dying within 48 h of surgery are usually elderly, emergency admissions with significant comorbidities who die of cardiovascular events. Timely, appropriate surgery and high quality pen-operative care delivered by consultant staff may prevent early post-operative mortality. (C) 2011 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

    Original languageEnglish
    Pages (from-to)1-5
    Number of pages5
    JournalSurgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
    Volume10
    Issue number1
    DOIs
    Publication statusPublished - Feb 2012

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