Thirty-Day Postoperative Mortality Risk Estimates and 1-Year Survival in Veterans Health Administration Surgery Patients

Smith, Tracy; Li, Xinli; Nylander, William; Gunnar, William

doi:10.1001/jamasurg.2015.4882

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…Our findings are consistent with other recent estimates of 30 day and 1 yr mortality after high-risk surgery 26 and another recent epidemiological study of ICU use in Medicare beneficiaries undergoing major surgical procedures in the USA. 12 The latter study suggested little consensus on admission criteria and no evidence of improved outcome associated with routine ICU admission.…”

Section: Discussionsupporting

confidence: 93%

Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study

Gillies¹,

Harrison

Pearse

et al. 2017

British Journal of Anaesthesia

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Section: Discussionsupporting

confidence: 93%

Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study

Gillies¹,

Harrison

Pearse

et al. 2017

British Journal of Anaesthesia

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“…Persistent SIRS appears to be a useful metric to gauge the therapeutic efficacy and prognosis following PC. These findings gain relevance in the context of recent work by Smith et al [26] which reinforced the validity of measuring 30-day mortality by demonstrating significant correlation to long-term outcomes. While 30-day mortality remains an important benchmark, our survival curves suggest that measuring 90-day mortality captures a substantial number of deaths which appear to be temporally related to the inciting event.…”

Section: Discussionsupporting

confidence: 71%

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

et al. 2017

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Background Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors. Methods We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group). Results The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6–30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1–186)], disseminated cancer [7.5 (2.1–26)], and congestive heart failure [3.9 (1.4–11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048). Conclusions Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.

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“…There was a higher risk of mortality in the 14 days following day 365 among liver transplant recipients at non–low‐performing programs; however, this was not observed in the 30 days following day 365, limiting the credence of this finding. Altogether, this is consistent with other studies from the surgical literature which have looked at mortality in the time period immediately following the 30‐day mortality metric used to assess surgical procedures, with no evidence of increased mortality in the period immediately after 30 days 22‐24 …”

Section: Discussionsupporting

confidence: 89%

Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States

Nathan

Blebea

Chatterjee

et al. 2020

Clinical Transplantation

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Introduction One‐year post‐transplant survival is a significant quality measure for solid organ transplant programs in the United States. It is not known whether the use of this metric is associated with changes in life‐sustaining clinical practices that would delay mortality for solid organ recipients until just beyond the one‐year time point. Methods We compared trends in mortality in the time period immediately preceding the one‐year post‐transplant mark compared to the period immediately after using second‐order Cox proportional hazard regression models. Results Among recipients of heart, liver, and lung transplantation, mortality did not decrease significantly in the period immediately before day 365 or increase in the 14 days thereafter. There was an increased adjusted hazard of mortality in the 30 days following day 365 among lung transplant recipients (HR 1.33, 95% CI 1.03‐1.72, P = .03) with a 0.76% absolute mortality rate (94 deaths) in month 12 following lung transplantation and a 1.14% absolute mortality rate in month 13 (113 deaths). Conclusion Although we did not find evidence that life‐sustaining treatment is routinely continued until just beyond the one‐year mark in heart and liver transplantation recipients, there was an unexpected increased risk of mortality in the 30 days following day 365 among lung transplant recipients.

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Thirty-Day Postoperative Mortality Risk Estimates and 1-Year Survival in Veterans Health Administration Surgery Patients

Cited by 20 publications

References 27 publications

Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study

Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States

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