Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study

Abstract

Background: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. Methods: A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. Results: The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02-4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16-1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87-0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53-4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62-10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01-1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29-3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85-5.52), p < 0.001). Conclusions: Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients' decision making and care planning.

Olfactory Dysfunction Predicts Frailty and Poor Postoperative Outcome in Older Patients Scheduled for Elective Non-Cardiac Surgery

“…Obviously, the figures of perioperative morbidity and mortality varies greatly in the literature according to type of surgeries, the type of patients and the urgency of surgery. Given our “real-life” older population, the wide range of surgeries performed with an elective setting, these outcome data seem comparable to other studies ( 28 – 30 ). Importantly, we show that anosmia is a predictor of poor postoperative outcome.…”

Missed Opportunities and Health Disparities for Advance Care Planning Before Elective Surgery in Older Adults

“…23 We also reported a 1-year mortality rate of 6.6%, which is similar to other data on 1-year all-cause mortality among postelective surgery patients. 24,25 In line with other reports, the 30-day mortality of 0.7% was low but then increased over the subsequent postoperative year. A greater proportion of patients who died within the first 90 days lacked ACP documentation compared to those who died after 90 days.…”

A risk scoring system integrating postoperative factors for predicting early mortality after major non‐cardiac surgery

“…Preoperative hematocrit was found as the ninth most important feature in cohort 1, whereas pre‐ or postoperative hematocrit was not selected among the top 10 features in cohort 2. As a result, hematocrit was not included in our scoring system, although preoperative anemia reportedly increases mortality after non‐cardiac surgery 4,40,41 . Intraoperative RBC transfusion of 1 or 2 units is known to be associated with a higher risk of 30‐day mortality and morbidity after non‐cardiac surgery 24–26 .…”

“…As a result, hematocrit was not included in our scoring system, although preoperative anemia reportedly increases mortality after non‐cardiac surgery. 4 , 40 , 41 Intraoperative RBC transfusion of 1 or 2 units is known to be associated with a higher risk of 30‐day mortality and morbidity after non‐cardiac surgery. 24 , 25 , 26 In our study, all patients received an intraoperative RBC transfusion and there was a definite association between the amount of packed RBC and the risk of 1‐week mortality, with a dramatic increased mortality risk when transfused with greater than or equal to 10 units.…”