Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Surgeon. 2012 Feb;10(1):1-5. doi: 10.1016/j.surge.2011.01.005. Epub 2011 Feb 1.
Comorbidity and emergency intervention are established risk factors for post-operative mortality. This study sought to identify adverse events associated with death within 48 h of general surgical procedures.
All general surgical patients who died within 48 h of operative intervention from 2002-2006 in Scotland underwent retrospective peer review using established Scottish Audit of Surgical Mortality (SASM) methodologies (www.SASM.org).
During the 5 years, 1299 patients died within 48 h of surgery, 1134 (87.3%) admitted as an emergency, with a mean age of 71 years; 898 patients (69.1%) were ASA grade 3, 4 or 5; 727 (56.0%) patients had cardiovascular, 398 (30.6%) respiratory and 191 (14.7%) renal comorbidity. Over time exploratory laparotomy (443, 34.1%) was carried out less often (p = 0.004) prior to death due to cardiovascular disease (435, 33.5%), mesenteric ischaemia (264, 20.3%) or multi-organ failure (255, 19.6%). The decision to operate by consultant surgeons rose significantly (p < 0.001). Adverse events were identified in 721 of the 1299 cases; concerns about inappropriate operations (p = 0.018) and poor pre-operative assessment (p = 0.012) decreased significantly.
Patients dying within 48 h of surgery are usually elderly, emergency admissions with significant comorbidities who die of cardiovascular events. Timely, appropriate surgery and high quality peri-operative care delivered by consultant staff may prevent early post-operative mortality.
合并症和紧急干预是术后死亡的既定危险因素。本研究旨在确定与手术 48 小时内死亡相关的不良事件。
2002-2006 年期间，苏格兰所有在手术干预后 48 小时内死亡的普通外科患者均采用既定的苏格兰外科死亡率审核 (SASM) 方法进行回顾性同行评审 (www.SASM.org)。
在 5 年期间，有 1299 名患者在手术后 48 小时内死亡，其中 1134 名（87.3%）作为急诊入院，平均年龄为 71 岁；898 名患者（69.1%）ASA 分级为 3、4 或 5 级；727 名患者（56.0%）存在心血管、398 名患者（30.6%）存在呼吸和 191 名患者（14.7%）存在肾脏合并症。随着时间的推移，由于心血管疾病（435 例，33.5%）、肠系膜缺血（264 例，20.3%）或多器官衰竭（255 例，19.6%），在死亡前进行剖腹探查术（443 例，34.1%）的次数减少（p=0.004）。顾问外科医生决定进行手术的次数显著增加（p<0.001）。在 1299 例病例中，有 721 例发现了不良事件；对不适当手术的担忧（p=0.018）和术前评估不佳（p=0.012）的情况显著减少。
在手术 48 小时内死亡的患者通常是年龄较大的急诊入院患者，且存在严重的合并症，死于心血管事件。及时、适当的手术和由顾问人员提供的高质量围手术期护理可能预防术后早期死亡。
