Older age (≥65 years), metastatic cancer, low Glasgow Coma Scale score (≤8), and elevated lactate (≥2 mmol/L) were independently associated with increased in-hospital mortality of 11.9% after emergency noncardiac surgery in Japanese ICU patients.
Observational (n=18,781)
Yes
Readily obtainable physiological variables within the first 24 hours of ICU admission after emergency noncardiac surgery independently predict in-hospital mortality and can aid in early risk stratification.
Effect estimate: aOR 1.89 for age ≥65; aOR 2.60 for metastatic cancer; aOR 3.38 for GCS ≤8; aOR 1.58 for lactate ≥2 mmol/L (95% CI 95% CI 1.69-2.13 for age ≥65; 2.07-3.26 for metastatic cancer; 2.96-3.87 for GCS ≤8; 1.43-1.76 for lactate ≥2 mmol/L)
Emergency noncardiac surgery carries a substantial risk of death, yet factors influencing outcomes immediately after surgery remain unclear. We conducted a multicenter retrospective cohort study of adults admitted to intensive care units immediately after emergency noncardiac surgery between January 2020 and December 2023, using data from the nationwide Japanese Intensive Care Patient Database (JIPAD) registry. Among 18,781 patients, 2,233 (11.9%) died during hospitalization. Independent predictors of mortality included older age (≥65 years; adjusted odds ratio aOR 1.89, 95% confidence interval CI 1.69–2.13), metastatic cancer (aOR 2.60, 95% CI 2.07–3.26), and physiological abnormalities within 24 hours of admission, specifically low Glasgow Coma Scale score (≤8; aOR 3.38, 95% CI 2.96–3.87) and elevated lactate (≥2 mmol/L; aOR 1.58, 95% CI 1.43–1.76). Hypotension, tachycardia, and renal dysfunction were also associated with mortality. These associations remained consistent across age groups and sensitivity analyses that excluded low-risk surgical categories and addressed missing data. In this nationwide cohort, the in-hospital mortality rate was 11.9% after emergency noncardiac surgery. Readily obtainable postoperative variables within the first 24 hours of ICU admission may support prompt risk stratification and help identify high-risk patients who require intensified monitoring.
Goto et al. (2026) conducted an observational in Adults (≥18 years) admitted to intensive care units immediately after emergency noncardiac surgery in Japan (n=18,781). Older age (≥65 years), metastatic cancer, low Glasgow Coma Scale score (≤8), and elevated lactate (≥2 mmol/L) were independently associated with increased in-hospital mortality of 11.9% after emergency noncardiac surgery in Japanese ICU patients.