Risk factors and mortality after elective and emergent laparatomies for oncological procedures in 899 patients in the intensive care unit: a retrospective observational cohort studyReport as inadecuate




Risk factors and mortality after elective and emergent laparatomies for oncological procedures in 899 patients in the intensive care unit: a retrospective observational cohort study - Download this document for free, or read online. Document in PDF available to download.

Patient Safety in Surgery

, 7:29

First Online: 05 September 2013Received: 18 June 2013Accepted: 28 August 2013

Abstract

BackgroundAbdominal surgeries for cancer are associated with postoperative complications and mortality. A view of the success of anaesthetic, surgical and critical care can be gained by analyzing factors associated with mortality in patients admitted to intensive care units ICUs. The objective of this study was to identify the postoperative mortality rate and the causes of perioperative death in high-risk patients after abdominal surgery for cancer. A secondary objective was to explore possible risk factors for death in scheduled and emergency surgeries, with a view to finding guidance on preventable risk factors.

MethodsAn observational study, in a 12-bed surgical ICU of a tertiary hospital. Patients admitted after abdominal surgery for cancer to the ICU for more than 24 hours’ care were included from January 1, 2008–December 31, 2009. Data were extracted from the minimum basic dataset. The main outcome considered was 90-day mortality.

ResultsOf 899 patients included, 80 8.9% died. Seven died within 48 hours of surgery, 18 died between 2 and 7 days, and 55 died after 7 days. Non-survivors were older and had more respiratory comorbidity, chronic liver disease, metastasis, and underwent more palliative procedures. 112 patients underwent emergency surgery; mortality in these patients for resection surgery was 32.5%; in the 787 patients who underwent scheduled surgery, mortality was 4.7% for resection procedures. The estimated odds ratios 95% confidence interval of preoperative patient factors in emergency surgery confirmed a negative association between survival and older age 0.96 0.91–1, the presence of respiratory comorbidity 0.14 0.02–0.77 and metastasis 0.18 0.05–0.6. After scheduled surgery, survival was negatively associated with age 0.93 0.90–0.96 and chronic liver disease 0.40 0.17–0.91. Analysis of complications after emergency surgery also indicated a negative association with sepsis 0.03 0.003–0.32, respiratory events 0.043 0.011–0.17 and cardiac events 0.11 0.027–0.45; after scheduled surgery, respiratory 0.03 0.01–0.08 and cardiac 0.11 0.02–0.45 events, renal failure 0.02 0.006–0.14 and neurological events 0.06 0.007–0.5.

ConclusionsAs most deaths occurred after discharge from the ICU, postoperative sepsis, respiratory and cardiac events should be watched carefully on the ward.

KeywordsCancer Abdominal surgery Intensive care Emergency Postoperative complications Mortality AbbreviationsCIConfident interval

ICUSurgical intensive care unit

SRSSurgical risk score.

Abstract

AntecedentesLa cirugía abdominal por cáncer se asocia a complicaciones postoperatorias y a mortalidad. El objetivo del presente estudio fue identificar la incidencia de mortalidad postoperatoria en pacientes intervenidos de cirugía abdominal por cáncer admitidos en una unidad de cuidados intensivos quirúrgicos ICUs. Un objetivo secundario fue determinar los factores de riesgo mortalidad en base a la condición de la cirugía electiva o urgente.

MétodoEstudio observacional durante el periodo Enero 1, 2008 a Diciembre 31, 2009 de todos los pacientes intervenidos de cirugía abdominal admitidos en una ICUs de 12 camas por un espacio superior a las 24 horas. Los datos fueron extraídos del conjunto mínimo de datos. La variable principal fue la mortalidad a los 90 días.

ResultadosSe incluyeron 899 pacientes, 80 8.9% fallecieron. Siete en las 48 horas de la cirugía, 18 entre el segundo y el séptimo día y 55 después. Los pacientes fallecidos eran de mayor edad, tenían asociadas patología respiratoria, afectación hepática, metástasis y los procedimientos quirúrgicos paliativos fueron más comunes. 112 pacientes fueron intervenidos de urgencia con una mortalidad para la cirugía resectiva del 32.5%; en los 787 pacientes electivos, la mortalidad fue del 4.7%. La Odds intervalo de confianza 95% de los factores preoperatorios en la cirugía urgente confirmó la asociación negativa entre la supervivencia y la edad 0.96 0.91–1, la patología respiratoria 0.14 0.02–0.77 y las metástasis 0.18 0.05–0.6. En la cirugía electiva la supervivencia se asoció negativamente con la edad 0.93 0.90–0.96 y con la patología hepática crónica 0.40 0.17–0.91. Se observó una asociación negativa entre la supervivencia y la sepsis 0.03 0.003–0.32, las complicaciones respiratorias 0.043 0.011–0.17 y cardiacas 0.11 0.027–0.45 en la cirugía urgente; mientras que en la cirugía electiva la asociación negativa con la supervivencia se obtuvo para las complicaciones respiratorias 0.03 0.01–0.08, cardiacas 0.11 0.02–0.45, el fracaso renal 0.02 0.006–0.14 y las neurológicas 0.06 0.007–0.5.

ConclusionesLa mayor parte de las muertes sucedieron después del alta de la ICU, y se asociaron a la sepsis y a las complicaciones respiratorias y cardiacas.

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Author: Montserrat Mallol - Antoni Sabaté - Antonia Dalmau - Maylin Koo

Source: https://link.springer.com/article/10.1186/1754-9493-7-29







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