Predictors of mortality and complications in patients treated in intensive care following non-cardiac emergency surgery

Abstract

Background: Due to the increasing population and life expectancy, the number of patients undergoing emergency surgery is expected to increase. However, different surgical diagnoses that require emergency surgery cause various complications and morbidity. This study examines outcomes in patients undergoing emergency surgery, including in-hospital mortality and morbidity predictors.

Materials and Methods: A retrospective study was conducted of patients who underwent emergency surgery in a tertiary healthcare institution between 2014 and 2019 and were indicated for post-surgical intensive care unit (ICU). Demographic data, comorbidities, surgical indications and perioperative risk assessment data of the patients were collected. Outcomes included length of stay in ICU, need for inotrope agents, discharge status, and in-hospital mortality and morbidity. Multivariate logistic regression was used to identify predictors of in-hospital mortality.

Results: The mean age of 886 patient admissions was 52.3 years. The mortality rate (38.1%) of patients aged 65 and over who underwent emergency surgery was statistically significantly higher than other patients (p < 0.001). The American Society of Anesthesiologists (ASA) physical condition classification mean was 3E. The mortality rate was found to be higher in patients with high ASA, Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) III scores and preoperative leukocyte and neutrophil values (p <0.001).

Conclusions: Apart from APACHE II and SAPS III classifications and preoperative laboratory parameters such as leukocytes and lymphocytes, the ASA score can also predict mortality in the critically ill population requiring emergency surgery, and can be used to guide patient and family counseling.

Keywords

• Emergency
• Surgery
• Critical care
• Mortality
• ASA score

Predictors of mortality and complications in patients treated in intensive care following non-cardiac emergency surgery

Abstract

Amaç: Artan nüfus ve yaşam süresi nedeniyle acil cerrahi geçiren hastaların sayısının artması beklenmektedir. Bununla birlikte acil cerrahi gerektiren farklı cerrahi tanılar farklı komplikasyonlara ve morbiditeye neden olmaktadır. Bu araştırma, hastane içi mortalite ve morbidite öngörücüleri de dahil olmak üzere, acil cerrahi uygulanan hastalardaki sonuçları incelemektedir.
Materyal ve Metot: 2014 ve 2019 yılları arasında üçüncü basamak bir sağlık kuruluşunda acil cerrahi geçiren ve cerrahi sonrası yoğun bakım endikasyonu konulan hastaların retrospektif bir çalışması yapıldı. Hastaların demografik verileri, komorbiditeleri, cerrahi endikasyonları ve perioperatif risk değerlendirme verileri toplandı. Sonuçlar, yoğun bakımda kalış süresi, inotrop ihtiyacı, taburculuk durumu ve hastane içi mortalite ve morbiditeyi içeriyordu. Hastane içi mortalite belirleyicilerini belirlemek için çok değişkenli lojistik regresyon kullanıldı.
Bulgular: 886 hasta başvurusunun ortalama yaşı 52.3 idi. Acil cerrahi uygulanan 65 yaş ve üstü hastaların mortalite oranı (%38.1) diğer hastalara göre istatistiksel açıdan anlamlı olarak yüksekti (p < 0.001). Amerikan Anesteziyologlar Derneği (ASA) fiziksel durum sınıflandırması ortalaması 3E idi. ASA, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi (APACHE II), Basitleştirilmiş Akut Fizyoloji Skoru (SAPS) puanlamaları ve preoperatif lökosit, ve nötrofil değerleri yüksek olan hastalarda mortalite oranı daha yüksek saptandı (p <0.001).
Sonuç: APACHE II ve SAPS III sınıflamaları ve lökosit, lenfosit gibi preoperatif bakılan laboratuar parametreleri dışında ASA skoru da acil cerrahi gerektiren kritik hasta popülasyonunda mortaliteyi öngörebilir, ayrıca hasta ve aile danışmanlığına rehberlik etmek için kullanılabilir.

Keywords

• Emergency
• Surgery
• Critical care
• Mortality
• ASA skoru

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