medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2006, Number 1

<< Back Next >>

Rev Invest Clin 2006; 58 (1)

Mortality associated factor in major surgery: retrospective analysis in a referral center

Medina-Franco H, Ramos-De la Medina A, Torres-Villalobos G, Tapia-Cid de León H

Language: Spanish
References: 16
Page: 9-14
PDF size: 96.93 Kb.


ABSTRACT

Background. There are very few studies that analyze surgical morbidity and mortality in the general population and the factors associated with those events Objective. To determine factors associated to mortality in surgical procedures performed in a tertiary referral center in Mexico City. Methods. We retrospectively analyze surgical mortality in 4,157 consecutive surgical procedures performed in a oneyear period from 1/1/2000 through 12/31/2000. Categorical variables were analyzed with the chi-square test and continuous variables with the t-Student test. Significance was defined as p ‹ 0.05. Results. During the study period there were 76 postoperative deaths, representing a mortality rate of 1.82%. Mean patient’s age in the entire cohort was 48.7 ± 17.6 years and for the patients who died in the postoperative period 57.8 ± 17.8 years (p ‹ 0.05). Sixty-six percent of deaths were attributed to the primary or surgical disease. In 33.8% of postoperative deaths an adverse event was identified as responsible for the outcome. In 23% of cases there was a potentially preventable event, representing 0.3% of surgical procedures. Most patients (96.9%) had at least one comorbid condition and 61.5% had two or more. Almost 80% of surgical deaths occurred in patients with ASA score III of IV and albumin levels below 3.5 g/dL. Most common cause of death was sepsis, reported in 35% of patients who died in the postoperative period Conclusion. Surgical mortality in our series is low. In 0.3% of procedures it was detected a potentially preventable event. Postoperative deaths occurred in older patients with low albumin levels.


REFERENCES

  1. Calland JF, Adams RB, Benjamín DK, O’Connor MJ, Chandrasekhara V, Guerlain S, Jones RS. Thirty-day postoperative death rate at an academic medical center. Ann Surg 2002; 235: 690-8.

  2. Gawande AA, Thomas EJ, Zinner MJ, et al. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 1999; 126: 66-75.

  3. Birkemeyer NJ, Marrin CA, Morton JR, et al. Decreasing mortality for aortic and mitral valve surgery in Northern New England. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 2000; 70: 432-7.

  4. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study. N Eng J Med 1991; 324: 370-6.

  5. Smith T. Perioperative deaths-detection by linkage of hospital discharge and death registration sub-files. Health Bull 1993; 51: 299-309.

  6. Vincent C, Taylor-Adams S, Chapman E, et al. How to investigate and analyse clinical incidents: Clinical Risk Unit and Association of Litigation and Risk Management protocol. BMJ 2000; 320: 777-81.

  7. Medina-Franco H, Ramos-Gallardo G, Orozco H, Mercado MA. Factores pronósticos en cáncer de vesícula. Rev Invest Clin 2005; 57: 662-5.

  8. Lien YC, Hsieh CC, Wu YC, Hsu HS, Hsu WH, Wang LS, Huang MH, Huang BS. Preoperative serum albumin level lis a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg 2004; 8: 1041-8.

  9. Leape L. The preventability of medical injury. In: Bogner MS, ed. Human error in medicine. Hillsdale, NJ: Lawrence Erlbaum Associates; 1994, pp. 13-25.

  10. Brennan TA, Leape LL. Adverse events, negligent in hospitalized patients: results from the Harvard Medical Practice Study. Perspect Health Risk Manage 1991; 11: 2-8.

  11. Leape LL. Patient safety: reporting of adverse events. N Eng J Med 2002; 347: 1633-8.

  12. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing intern’s hours on serious medical errors in intensive care units. N Engl J Med 2004; 351: 1838-48.

  13. Blendon RJ, DesRoches C, Brodie M, et al. Patient safety: views of practicing physicians and the public on medical errors. N Eng J Med 2002; 347: 1933-40.

  14. Altman DE, Clancy C, Brendon RJ. Improving patient safety-five years after the IOM report. N Engl J Med 2004; 351: 2041-3.

  15. Vincent C, Taylor-Adams S, Chapman E, et al. How to investigate and analyse clinical incidents: Clinical Risk Unit and Association of Litigation and Risk Management protocol. BMJ 2000; 320: 777-81.

  16. Nuland SB. Mistakes in the operating room-error and responsibility. N Engl J Med 2004; 351: 1281-3.




2020     |     www.medigraphic.com