Journal article
Mortality in Hospitalized Patients After Elective and Nonelective Surgery
Anesthesiology (Philadelphia), Vol.143(1), pp.62-70
07/2025
DOI: 10.1097/ALN.0000000000005477
PMID: 40146929
Abstract
Perioperative death globally has been described as the third leading cause of death behind heart disease and malignant neoplasm and ahead of cerebrovascular disease. However, studies of all-cause perioperative mortality have not distinguished patients who were outpatients preoperatively ("elective") from patients having urgent surgery or having surgery on a day after their date of admission ("nonelective"). Strategies for reducing overall perioperative mortality are affected by whether most deaths occur after elective or nonelective surgery.
We studied all adult patients undergoing major diagnostic or therapeutic surgery in Florida in 2021 and 2022 hospitalized ≥2 midnights. We compared those who survived to discharge or died between the elective and nonelective groups. Major hospital-acquired complications were considered as sensitivity analyses. The diversity of procedures (ICD-10-PCS codes) was quantified using the inverse of the internal Herfindahl.
Among the 1,245,537 hospitalizations studied, the nonelective group accounted for 94.5% (95% CI 94.0-95.1%) of the 20,874 in-hospital deaths (p < 0.0001 vs 50% ["most"]). The nonelective group also accounted for most (70.0%) hospitalizations studied. The relative risk of death in the elective vs non-elective group was 0.13 (95% CI 0.12-0.14, p < 0.0001 vs. 1.0). The relative risks of acute kidney injury, hospital-acquired pneumonia, a major adverse cardiovascular event, and infection were all <1.0 in the elective group. Hundreds of different ICD-10-PCS occurred commonly among patients who died, in both groups.
Results of previous studies of all-cause perioperative mortality should not be applied to patients having elective major surgery because most deaths (≈95%) and most cases (70%) are in patients having nonelective major surgery (i.e., already admitted to the hospital or undergoing trauma-related surgery). From a public health perspective, interventions to reduce postoperative mortality should be primarily focused on patients who are inpatients before their first major surgical procedure.
Details
- Title: Subtitle
- Mortality in Hospitalized Patients After Elective and Nonelective Surgery
- Creators
- Richard H Epstein - University of MiamiFranklin Dexter - University of IowaBrenda G Fahy - University of Florida
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.143(1), pp.62-70
- DOI
- 10.1097/ALN.0000000000005477
- PMID
- 40146929
- NLM abbreviation
- Anesthesiology
- ISSN
- 1528-1175
- eISSN
- 1528-1175
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Language
- English
- Electronic publication date
- 03/27/2025
- Date published
- 07/2025
- Academic Unit
- Anesthesia
- Record Identifier
- 9984802408902771
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