Key result
Pre-operative patient factors, notably age 90+ (OR 4.0) and ASA 4 status (OR 12.4), were more strongly associated with 30-day mortality than surgery type in older non-cardiac surgical patients.
Why the study?
What pre-operative factors and complications are associated with 30-day mortality in older patients undergoing non-cardiac surgery?
What pre-operative factors and complications are associated with 30-day mortality in older patients undergoing non-cardiac surgery?
Answers are grounded in this paper and cite their sources.
In older patients undergoing non-cardiac surgery, patient-specific factors such as age, ASA physical status, and pre-operative albumin levels have a stronger association with 30-day mortality than the type of surgery performed.
We conducted a prospective study of non-cardiac surgical patients aged 70 years or more in 23 hospitals in Australia and New Zealand. We studied 4158 consecutive patients of whom 2845 (68%) had pre-existing comorbidities. By day 30, 216 (5%) patients had died, and 835 (20%) suffered complications; 390 (9.4%) patients were admitted to the Intensive Care Unit. Pre-operative factors associated with mortality included: increasing age (80-89 years: OR 2.1 (95% CI 1.6-2.8), p < 0.001; 90+ years: OR 4.0 (95% CI 2.6-6.2), p < 0.001); worsening ASA physical status (ASA 3: OR 3.1 (95% CI 1.8-5.5), p < 0.001; ASA 4: OR 12.4 (95% CI 6.9-22.2), p < 0.001); a pre-operative plasma albumin < 30 g.l⁻¹ (OR: 2.5 (95% CI 1.8-3.5), p < 0.001); and non-scheduled surgery (OR 1.8 (95% CI 1.3-2.5), p < 0.001). Complications associated with mortality included: acute renal impairment (OR 3.3 (95% CI 2.1-5.0), p < 0.001); unplanned Intensive Care Unit admission (OR 3.1 (95% CI 1.9-4.9), p < 0.001); and systemic inflammation (OR 2.5 (95% CI 1.7-3.7), p < 0.001). Patient factors often had a stronger association with mortality than the type of surgery. Strategies are needed to reduce complications and mortality in older surgical patients.
No takes yet. Share an insight, caveat, or question.
Story et al. (2010) studied this question. Pre-operative patient factors, notably age 90+ (OR 4.0) and ASA 4 status (OR 12.4), were more strongly associated with 30-day mortality than surgery type in older non-cardiac surgical patients.
Synapse has enriched 10 related papers. Consider them for comparative context: