Predictors of In‐Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations

Abstract

Background Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. Materials and methods This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission. Results The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The “weekend” effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission. Conclusion Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

“…The in-hospital mortality during surgery was recently reported to be lower in women than men. 41,691 In contrast, among 609 735 patients who underwent elective NCS between 2009 and 2016, the odds of post-operative 90 day mortality were higher among women with HF than men with HF. 692 Further studies are needed to provide more information about outcome differences between men and women in NCS.…”

Sex‐Based Differences in Survival Among Patients with Acute Abdomen Undergoing Surgery in Malawi: A Propensity Weighted Analysis

“…The results of prior studies on this topic are conflicting. Two extensive studies from Canada and Poland reported statistically significantly lower mortality among females across various surgical procedures [ 23 , 24 ]. An American study also found significantly lower postoperative sepsis rates among females, but the relationship between sex and mortality was not evaluated [ 25 ].…”

Sex differences in post-operative outcomes following non-cardiac surgery

“…However, ascertainment of longer-term outcomes allows for the added ability to capture variation in outcomes due to both psychosocial factors and biological differences. Previous studies with short term follow-up have identified that female sex is associated with a lower in-hospital mortality risk among patients undergoing cardiac and non-cardiac surgery [ 12 ] and that perioperative major adverse cardiovascular events occurred more among male patients [ 13 ]. Our study builds on these studies by evaluating longer-term post-operative outcomes and demonstrating a consistent increase in all-cause mortality and all-cause hospitalization among male patients.…”