Incidence, Risk Factors, and Complications Associated With In-Hospital Mortality in Emergency Surgery at Ramathibodi Hospital: A Retrospective Study

Nichawan Wirachpisit; Chidchanok Choovongkomol; Rojnarin Komonhirun; Pensiri Poomhirun; Wichai Ittichaikulthol

doi:10.14456/rmj.2018.19

Authors

Nichawan Wirachpisit Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Chidchanok Choovongkomol Anesthesia Unit, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Rojnarin Komonhirun Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Pensiri Poomhirun Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Wichai Ittichaikulthol Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.19

Keywords:

Anesthesia, Emergency, Mortality

Abstract

Background: Previous studies have identified several risk factors associated with anesthesia and emergency surgery. However, there are no precise data for emergency surgery in Ramathibodi Hospital.

Objective: To identify the incidence and risk factors associated with in-hospital mortality and perioperative complications in patients undergoing emergency surgery at Ramathibodi Hospital.

Methods: This was a retrospective study of all patients undergoing emergency surgery at Ramathibodi Hospital from June 2014 to May 2015. Data collected included sex, age, American Society of Anesthesiologists (ASA) classification, comorbidities, type and duration of surgical procedures and period during which it was performed, and major complications. Statistical analysis was performed to determine the differences between groups with the significant level at P < 0.05.

Results: A total of 3520 patients underwent emergency surgery. In-hospital mortality and perioperative complication rate were 0.68% and 22.81%, respectively. Several risk factors associated with intraoperative complications such as extreme age < 1 year (odds ratio [OR], 3.56; 95% CI, 1.6 - 7.93); ASA classification > II (OR, 16.76; 95% CI, 10.05 - 27.94); cardiovascular/thoracic surgery (OR, 5.91; 95% CI, 3.29 - 10.61); pediatric surgery (OR, 7.62; 95% CI, 3.38 - 17.17); respiratory comorbidities (OR, 4.37; 95% CI, 3.43 - 5.58); sepsis (OR, 6.21; 95% CI, 4.06 - 9.49); and post cardiac arrest (OR, 9.29; 95% CI, 2.04 - 42.30).

Conclusions: The incidence of in-hospital mortality and perioperative complications after emergency surgery were 0.68% and 22.81%, respectively. Several risk factors related to major complications should be aware by anesthesia providers.

References

Matsuyama T, Iranami H, Fujii K, Inoue M, Nakagawa R, Kawashima K. Risk factors for postoperative mortality and morbidities in emergency surgeries. J Anesth. 2013;27(6):838-843. doi:10.1007/s00540-013-1639-z.

Braz LG, Braz DG, Cruz DS, Fernandes LA, Módolo NS, Braz JR. Mortality in anesthesia: a systematic review. Clinics (Sao Paulo). 2009;64(10):999-1006. doi:10.1590/S1807-59322009001000011.

Arbous MS, Meursing AE, van Kleef JW, et al. Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology. 2005;102(2):257-268.

Siriphuwanun V, Punjasawadwong Y, Lapisatepun W, Charuluxananan S, Uerpairojkit K. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery. Risk Manag Healthc Policy. 2014;7:155-162. doi:10.2147/RMHP.S67935.

Kyokong O, Charuluxananan S, Werawatganon T, Termsombatborworn N, Leelachiewchankul F. Risk factors of perioperative death at a university hospital in Thailand: a registry of 50,409 anesthetics. Asian Biomed. 2008;2(1):51-58.

Pignaton W, Braz JR, Kusano PS, et al. Perioperative and anesthesia-related mortality: An 8-year observational survey from a tertiary teaching hospital. Medicine (Baltimore). 2016;95(2):e2208. doi:10.1097/MD.0000000000002208.

Charuluxananan S, Chinachoti T, Pulnitiporn A, Klanarong S, Rodanant O, Tanudsintum S. The Thai Anesthesia Incidents Study (THAI Study) of perioperative death: a nalysis of risk factors. J Med Assoc Thai. 2005;88 Suppl 7:S30-S40.