Using predicted 30 day mortality to plan postoperative colorectal surgery care: a cohort study.

Swart M, Carlisle JB, Goddard J

Br J Anaesth. 2017 Jan;118(1):100-104. doi: 10.1093/bja/aew402.

BACKGROUND: Preoperative identification of high-risk surgical patients might help
to reduce postoperative morbidity and mortality. Using a patient’s predicted
30 day mortality to plan postoperative high-dependency unit (HDU) care after
elective colorectal surgery might be associated with reduced postoperative
METHODS: The 30 day postoperative mortality was predicted for 504 elective
colorectal surgical patients in a preoperative clinic. The prediction was used to
determine postoperative surgical ward or HDU care. Those with a predicted 30 day
mortality of 1-3% mortality, and thus deemed at intermediate risk, had either
planned HDU care (n=68) or planned ward care (n=139). The main outcome measures
were emergency laparotomy and unplanned critical care admission.
RESULTS: There were more emergency laparotomies and unplanned critical care
admissions in patients with a predicted 30 day mortality of 1-3% who went to an
HDU after surgery compared with patients who went to a ward: 0 vs 14 (10%),
P=0.0056 and 0 vs 22 (16%), P=0.0002, respectively.
CONCLUSIONS: Planned postoperative critical care was associated with a lower rate
of complications after elective colorectal surgery.