Predictors of in-hospital mortality in patients undergoing elective surgery in a university hospital: a prospective cohort

Stahlschmidt, Adriene; Novelo, Betânia; Freitas, Luiza Alexi; Passos, Sávio Cavalcante; Dussán‐Sarria, Jairo Alberto; Félix, Elaine Aparecida; Gamermann, Patrícia Wajnberg; Caumo, Wolnei; Stefani, Luciana Paula Cadore

doi:10.1016/j.bjane.2018.04.009

Cited by 10 publications

(12 citation statements)

References 26 publications

(28 reference statements)

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“…Reason for such huge discrepancy can be attributed to differences in mean age groups and associated advances in healthcare technology in developed countries that helps greatly in preoperative screenings. Among the comorbidities mentioned, anemia accounted for one-fourth, which is also similar to the study done in Brazil by Stahlschmidt A et.al (16).…”

Section: Discussionsupporting

confidence: 87%

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

Dandena¹,

Leulseged²,

Suga³

et al. 2020

Ethiop J Health Sci

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BACKGROUND: Inpatient mortality is among regularly collected data in Key performance indicators in the Ethiopian healthcare system, and it is generally reported to the Federal Ministry of Health and is used as one of inpatient services quality indicators. This study was undertaken to identify the magnitude, causes and pattern of mortalities among patients who are admitted and treated in surgical wards in Saint Paul Hospital Millennium Medical College for a period of three years.METHODS: A retrospective review was done on all patients admitted and died in the Department of Surgery in St. Paul's Hospital Millennium Medical College from January 1, 2016–Dec 30, 2018.RESULT: There were 10,259 admissions over three years and out of which there were 350 deaths between 2016-2018 making a crudemortality rate of 3.41 %. The commonest mode of admission was for emergency conditions, 195(62.7%). Out of emergency admissions, 139 mortalities were from general emergency surgery and 75 patients died from elective general surgery admissions. Eighty-four (26.9%) patients had comorbidity and the commonest comorbidity was anemia 21(25%). The commonest possible cause of death was multi-organ failure secondary to septic shock, 159(51%). Mortality rate patterns along the three years (2016, 2017, 2018) showed 3.34% (112/3360), 2.87% (102/3552) and 2.92% (98/3347) respectively.CONCLUSION: The mortality rate of this study is much higher than global rates, but still there is a significant difference from other developing countries and also other researches in this country. Pattern of mortality did not show any difference across years of the study period.

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Section: Discussionsupporting

confidence: 87%

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

Dandena¹,

Leulseged²,

Suga³

et al. 2020

Ethiop J Health Sci

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“…The profile of patients is very similar to other tertiary or high complexity institutions, not demonstrating any significant difference (STAHLSCHMIDT et al, 2018;PEREIRA et al, 2019;GONZÁLES et al, 2008;MAZZA et al, 2008). Furthermore, the rate of inadequate transport is really close to other studies with 44% (WINTER, 2010) and other studies show clinical events occurred in 7.5 and 9.8% of transports and nonclinical events occurred in 8.0% and 1.9% of transports (VEIGA et al, 2019, MENEGUIN et al, 2014 During transportation, the majority of the patients covered the route in walking conditions.…”

Section: Discussionsupporting

confidence: 58%

Coming and going to a surgical center, the evaluation of risks in transport of patients in a university hospital in Brazil

et al. 2020

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The patient’s in-hospital transport is an activity that must be performed with safety and quality and involves considerable risks, especially for surgical patients. The objective of this study was to evaluate the adequacy or not of transport of surgical patients from inpatient units to surgical centers and vice-versa. The transport and patient profile, the nursing workload, the professionals and conditions involved were assessed for each patient (or transport), and subsequently the transports were evaluated as inadequate (some non-conformity) or adequate. The transport was inadequate in 39.3% of the evaluations. The most common non-conformities were the lack of knowledge of the transport at the patient’s destination, incorrect documents, patient alone during the route, and absence of health professional during transport (when necessary). In this institution and in the period evaluated, the transport was mainly run by porter. Patients in rout to inpatient units have higher frequency of inadequate transport, mainly because of lack of communication with the destination unit. The increase in workload, evaluated by the Santos Score, also increased the risk of having inappropriate transport (OR = 1.21, CI95%: 1.08-1.16), and when the patients were grouped in minimal care versus non-minimal care, the latter also showed higher risk of inadequate transport. When the transports were evaluated separately by route, patients going to surgical centers had a higher risk when the Santos Score increased (OR = 1.168, CI95%: 1.07-1.27), and patients going to inpatient units had a lower risk when the Santos Score increased (OR = 0.605, CI95%: 0.46-0.80). In the last case, patients with a high workload were also accompanied by health professionals. The presence of a health professional when the patient was going to an inpatient unit also decreased the risk of inadequate transport (OR = 0.011, CI95%: 0.002-0.070). The patient returning to their origin unit showed more transport non-conformities. Perhaps the reason is the discredit attributed to risk in these patients once the surgical problem was solved. Thus, it is a fact that the patient nursing workload and the route of the transport were effective in predicting the risk of inadequate transport, being of great potential for practical use.

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“…The reason for this difference was because the later study included older patients (> 80 years unlike that of > 18 years). On the other hand, the mortality rate was reported from 2.3 to 48.5% for patients undergoing a different type of surgery and heterogeneous study population as well as different severity [8,[23][24][25][26]; indeed the death rate is high for low-income countries because of different reason [10,12], for instance, in America, the overall mortality rate was 0.28% [27].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, female gender, emergency admission, presence of Poly-pharmacy, and the presence of sepsis or in-hospital bloodstream infection were found to be independent predictors of in-hospital death at JUMC. Other studies showed that After adjusting for all co-morbidities, female gender [20,28] while in contrast male gender [11,21] and emergency surgery [8,10,11,21], development of in-hospital complications [7,17,18,22], sepsis [25] was an independent predictor for in-hospital mortality [8,28], but, there was no clear reason for the gender-related increase in mortality. The gender-related discrepancy in predicting mortality might be due to the difference in baseline disease or type of operation (general surgery-coronary artery bypass graft surgery-thoracic surgery) respectively.…”

Section: Discussionmentioning

confidence: 99%

Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study

Tefera

Feyisa

Umeta

et al. 2020

J of Pharm Policy and Pract

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Background: Data regarding prolonged length of hospital stay (PLOS) and in-hospital mortality are paramount to evaluate efficiency and quality of surgical care as well as for rational resource utilization, allocation, and administration. Thus, PLOS and in-hospital mortality have been used as a surrogate indicator of satisfactory treatment outcome and efficient utilization of resources for a given health institution. However, there was a scarcity of data regarding these issues in Ethiopia. Therefore, this study aimed to assess treatment outcome, length of hospital stay, in-hospital mortality, and their determinants. Methods: Health facility-based prospective observational study was used for three consecutive months among adult patients hospitalized for the surgical case. Socio-demographic, clinical history, medication history, in-hospital complications, and overall treatment outcomes were collected from the medical charts' of the patients, using a checklist from the day of admission to discharge. PLOS is defined as hospital stay > 75th percentile (≥33 days for the current study). To identify predictor variables for both PLOS and in-hospital mortality, multivariate logistic regression was performed at p-value < 0.05 using SPSS version 20. Written informed consent was sought and secured. Results: Of 269 study participants, 91.8% were improved and discharged. PLOS was recorded in 25.3%; at least 33 days of hospital stay. Overall in-hospital mortality was 4.8%; which is equal to an incidence rate of 0.00193 per person-days, 5.2% in-hospital sepsis, and 2.6% of Hospital-acquired pneumonia (HAP), during their hospital stay. After adjusting for other factors; female gender (p = 0.003), emergency admission (p = 0.015), presence of Poly-pharmacy (p = 0.017), and presence of sepsis (p = 0.006) were found to be independent predictors for in-hospital mortality. On top of this, female gender (p = 0.026), patients who was paid by government (p = 0.007), burn-related surgery (p = 0.049), presence of cancer (p = 0.027), > 2 antibiotic exposure (p < 0.0001), and waiting for surgery for > 7 days (p < 0.0001) were independent predictors for PLOS.

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Predictors of in-hospital mortality in patients undergoing elective surgery in a university hospital: a prospective cohort

Cited by 10 publications

References 26 publications

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

Magnitude and Pattern of Inpatient Surgical Mortality in a Tertiary Hospital in Addis Ababa, Ethiopia

Coming and going to a surgical center, the evaluation of risks in transport of patients in a university hospital in Brazil

Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study

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