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Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study

BACKGROUND: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. METHODS: A retrospective cohort s...

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Autores principales: Liew, Lydia Q., Teo, Wei Wei, Seet, Edwin, Lean, Lyn Li, Paramasivan, Ambika, Tan, Joanna, Lim, Irene, Wang, Jiexun, Ti, Lian Kah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956490/
https://www.ncbi.nlm.nih.gov/pubmed/31931774
http://dx.doi.org/10.1186/s12893-019-0654-x
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author Liew, Lydia Q.
Teo, Wei Wei
Seet, Edwin
Lean, Lyn Li
Paramasivan, Ambika
Tan, Joanna
Lim, Irene
Wang, Jiexun
Ti, Lian Kah
author_facet Liew, Lydia Q.
Teo, Wei Wei
Seet, Edwin
Lean, Lyn Li
Paramasivan, Ambika
Tan, Joanna
Lim, Irene
Wang, Jiexun
Ti, Lian Kah
author_sort Liew, Lydia Q.
collection PubMed
description BACKGROUND: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. METHODS: A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. RESULTS: The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02–4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16–1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87–0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53–4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62–10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01–1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29–3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85–5.52), p < 0.001). CONCLUSIONS: Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients’ decision making and care planning.
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spelling pubmed-69564902020-01-17 Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study Liew, Lydia Q. Teo, Wei Wei Seet, Edwin Lean, Lyn Li Paramasivan, Ambika Tan, Joanna Lim, Irene Wang, Jiexun Ti, Lian Kah BMC Surg Research Article BACKGROUND: While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. METHODS: A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. RESULTS: The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02–4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16–1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87–0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53–4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62–10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01–1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29–3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85–5.52), p < 0.001). CONCLUSIONS: Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients’ decision making and care planning. BioMed Central 2020-01-13 /pmc/articles/PMC6956490/ /pubmed/31931774 http://dx.doi.org/10.1186/s12893-019-0654-x Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Liew, Lydia Q.
Teo, Wei Wei
Seet, Edwin
Lean, Lyn Li
Paramasivan, Ambika
Tan, Joanna
Lim, Irene
Wang, Jiexun
Ti, Lian Kah
Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title_full Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title_fullStr Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title_full_unstemmed Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title_short Factors predicting one-year post-surgical mortality amongst older Asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
title_sort factors predicting one-year post-surgical mortality amongst older asian patients undergoing moderate to major non-cardiac surgery – a retrospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956490/
https://www.ncbi.nlm.nih.gov/pubmed/31931774
http://dx.doi.org/10.1186/s12893-019-0654-x
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