The Impact of Functional Dependence and Related Surgical Complications on Postoperative Mortality.
Functional dependency status
Postoperative mortality
Risk assessment
Surgical complication
Journal
Journal of medical systems
ISSN: 1573-689X
Titre abrégé: J Med Syst
Pays: United States
ID NLM: 7806056
Informations de publication
Date de publication:
25 Nov 2021
25 Nov 2021
Historique:
received:
28
07
2021
accepted:
05
10
2021
entrez:
25
11
2021
pubmed:
26
11
2021
medline:
30
11
2021
Statut:
epublish
Résumé
Functional dependency is a known determinant of surgical risk. To enhance our understanding of the relationship between dependency and adverse surgical outcomes, we studied how postoperative mortality following a surgical complication was impacted by preoperative functional dependency. We explored a historical cohort of 6,483,387 surgical patients within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). All patients ≥ 18 years old within the ACS-NSQIP from 2007 to 2017 were included. There were 6,222,611 (96.5%) functionally independent, 176,308 (2.7%) partially dependent, and 47,428 (0.7%) totally dependent patients. Within 30 days postoperatively, 57,652 (0.9%) independent, 15,075 (8.6%) partially dependent, and 10,168 (21.4%) totally dependent patients died. After adjusting for confounders, increasing functional dependency was associated with increased odds of mortality (Partially Dependent OR: 1.72, 99% CI: 1.66 to 1.77; Totally Dependent OR: 2.26, 99% CI: 2.15 to 2.37). Dependency also significantly impacted mortality following a complication; however, independent patients usually experienced much stronger increases in the odds of mortality. There were six complications not associated with increased odds of mortality. Model diagnostics show our model was able to distinguish between patients who did and did not suffer 30-day postoperative mortality nearly 96.7% of the time. Within our cohort, dependent surgical patients had higher rates of comorbidities, complications, and odds of 30-day mortality. Preoperative functional status significantly impacted the level of postoperative mortality following a complication, but independent patients were most affected.
Identifiants
pubmed: 34822038
doi: 10.1007/s10916-021-01779-8
pii: 10.1007/s10916-021-01779-8
pmc: PMC8709534
mid: NIHMS1763993
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL148640
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002245
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23HL148640
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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