11.11 Predictors of Morbidity and Mortality in Ambulatory Surgery

Posted on December 22, 2014

D. R. Cummings1, M. Garg1, C. Divino1  1Icahn School Of Medicine At Mount Sinai,Department Of Surgery,New York, NY, USA

Introduction:

The volume of ambulatory surgical procedures is increasing on a yearly basis in the United States, exceeding an estimated 34 million outpatient surgeries in the year 2006. As the US population continues to age, the burden of surgical illness will continue to fall upon an older cohort, with an increase in attendant comorbidities and perioperative morbidity and mortality. This study seeks to elucidate patient specific risk factors for perioperative morbidity and mortality in the outpatient setting.

Methods:
A retrospective analysis of the 2011 NSQIP data was used for this study. The most frequent general surgical procedures categorized as outpatient were analyzed. Univariate analysis of demographic information, comorbidities and complications were calculated.  The outcome variables of interest were 30-day morbidity and mortality. Multivariable logistic regression analyses were performed to identify predictors of the outcome variables.

Results:
Out of 442,149 surgical procedures registered in the NSQIP 2011 database, 88,256 were included in this study.  40% of the population was male (n=35,852) and 77% Caucasian (n=67,598). The most frequently represented cases were laparoscopic cholecystectomy (n=11,451), inguinal hernia repair (n=9,936), partial mastectomy (n=5,957), umbilical hernia repair (n=5,753) and laparoscopic appendectomy (n=5,714). There were 1,924 cases with a morbid outcome and 48 deaths. The most significant predictors of morbidity were ASA class, operative time in hours, female gender, BMI (mean 29.4), and dialysis dependence (p<0.0001).  The most significant predictors of mortality were ASA class (p<0.0001), functional status (p=0.0125), male gender (0.0131), and emphysema (0.0213).

Conclusion:

This study highlights several risk factors for perioperative morbidity and mortality in the outpatient surgical setting.  More investigation is necessary to identify ways to optimize these patients for surgery.