Perioperative medicine and mortality after elective and emergency surgery

Søreide, Kjetil; Story, David A; Walder, Bernhard

doi:10.1097/eja.0000000000000350

Cited by 3 publications

(2 citation statements)

References 29 publications

(27 reference statements)

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“…The temporal trend of increased numbers of and increased survival amongst ASA class 3 patients is interesting. Improved outcomes could reflect improved medical diagnostics with earlier detection of diseases, better treatment of comorbid conditions, progress in perioperative management, use of frailty assessment tools 27 , adherence to programs like “Enhanced Recovery After Surgery” and strategic programs decreasing postoperative complications 28 . Surgical development of for example laparoscopic and minimally invasive techniques, interventional radiology and other innovations have reduced the procedural invasiveness 29 , meaning that multimorbid elderly patients are now eligible for safer interventions.…”

Section: Discussionmentioning

confidence: 99%

Increasing perioperative age and comorbidity: a 16-year cohort study at two University hospital sites in Sweden

Leigard,

Hertzberg,

Konrad

et al. 2024

International Journal of Surgery

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Background: Increasing life expectancy affects all aspects of healthcare. During surgery elderly patients are prone to complications and have higher risk of death. We aimed to investigate if adult patients undergoing surgery at a large Swedish university hospital were getting older and sicker over time, and if this potential shift in age and illness severity was associated with higher patient mortality rates. Materials and methods: This was a 16-year cohort study on all surgical procedures performed in adult patients 2006-2021 at two sites of X University Hospital. Study data was obtained from the surgical system, electronic medical records and cause-of-death register. Information on age, sex, ASA-classification, date-, type-, acuity- and duration of surgery was collected. ICD-codes were used to calculate Charlson comorbidity index (CCI). Short-, medium- and long-term mortality rates were assessed. Logistic regression models were used to evaluate changes over time. Results: There were 622,814 surgical procedures 2006-2021. Age, ASA-classification and CCI increased over time (P<0.0001). The proportions of age ≥60 years increased from 41.8 to 52.8% and of ASA-class ≥3 from 22.5 to 47.6%. Comparing 2018-2021 with 2006-2009, odds ratios (95% confidence intervals) of 30-, 90- and 365-day mortality, adjusted for age, sex, non-elective surgery and ASA-classification, decreased significantly to 0.75 (0.71-0.79), 0.72 (0.69-0.76), and 0.76 (0.74-0.79), respectively. Conclusion: Although the surgical population got older and sicker during the 16-year study period, short-, medium- and long-term mortality rates decreased significantly. These demographic shifts must be taken into account when planning for future healthcare needs to preserve patient safety.

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Section: Discussionmentioning

confidence: 99%

Increasing perioperative age and comorbidity: a 16-year cohort study at two University hospital sites in Sweden

Leigard,

Hertzberg,

Konrad

et al. 2024

International Journal of Surgery

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“…Yet, survival rates of surgical patients were higher, speaking for the successful disposal of ICU beds in this group of patients 41 . Further studies are needed in an expanding surgical population with increasing proportions of elderly and sicker patients 16,42 …”

Section: Discussionmentioning

confidence: 99%

Exposure to surgery is associated with better long‐term outcomes in patients admitted to Swedish intensive care units

Jawad

Baigi

Chew

2020

Acta Anaesthesiol Scand

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Admission to the intensive care unit (ICU) is considered beneficial for patients with or at a high risk of developing serious pathophysiological derangements or adverse events. 1-3 Surgical patients constitute a substantial proportion of ICU patients, yet their outcomes are not well-studied. 4 It is not known which variables, including exposure to surgery prior to ICU admission, are independent risk factors for long-term mortality. This would be a clinically relevant investigation considering the equipoise regarding the value of ICU admission after non-cardiac surgery, 5 and has important implications for the allocation, distribution and cost of this limited resource. 6 Sweden has the second lowest number of ICU beds per capita in Europe and has a low ICU-to-acute care bed ratio. 7 The available

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Risk prediction instruments to guide perioperative care in elderly patients with advanced disease

Pinto

Rached

Walder

2016

European Journal of Anaesthesiology

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Perioperative medicine and mortality after elective and emergency surgery

Cited by 3 publications

References 29 publications

Increasing perioperative age and comorbidity: a 16-year cohort study at two University hospital sites in Sweden

Increasing perioperative age and comorbidity: a 16-year cohort study at two University hospital sites in Sweden

Exposure to surgery is associated with better long‐term outcomes in patients admitted to Swedish intensive care units

Risk prediction instruments to guide perioperative care in elderly patients with advanced disease

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