Predictors of adverse events in surgical admissions in Australia.

OBJECTIVE

The purpose of this study was to determine risk factors of adverse events in five surgical procedures.

DESIGN

Retrospective record review was used to determine adverse events and risk factors of 1,177 surgical admissions. Procedures included in this study were transurethral resection of prostate, hysterectomy, hip and knee arthroplasty, cholecystectomy and herniorrhaphy. Risk factors included comorbidity, lifestyle factors and medications. Stepwise multiple logistic regression was used to determine predictors of adverse events.

SETTING

Two teaching hospitals in regional New South Wales, Australia.

PARTICIPANTS

1,177 surgical admissions for five high volume procedures.

MAIN OUTCOME MEASURES

Identified predictors of adverse events in surgical admissions.

RESULTS

The adverse event rate was 23.1% for all procedures (range 17.5-33.7% for the five procedures). Two factors were strongly predictive of an adverse event in all surgical admissions: age >70 years [odds ratio (OR) 1.9, 95% confidence intervals (CI) 1.3-2.6] and duration of operation (P = 0.005). Other predictive factors were: contaminated surgical site (OR 2.1, 95% CI 1.2-3.7) and anaemia (OR 1.8, 95% CI 1.1-2.8). Predictive factors of individual procedures included: urine retention (transurethral resection of the prostate); extended duration of operation and asthma (hysterectomy); acute admissions and extended duration of operation (cholecystectomy); and warfarin type drugs, ethanol abuse, failed prostheses, GI ulcer/inflammation, rheumatoid arthritis, and ischaemic heart disease (hip and knee joint arthroplasty).

CONCLUSIONS

The results of this study suggest that five factors should be routinely monitored for patients undergoing these procedures: age >70 years, type of procedure, duration of operation >2 h, contaminated surgical site and anaemia.