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Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery
Monir Jawad1, Amir Baigi, Anders Oldner
1From the Department of Anaesthesiology and Intensive Care, Central Hospital in Kristianstad, Kristianstad (MJ), Department of Primary Healthcare, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg (AB), Department of Anaesthesiology, Karolinska University Hospital and Institute, Surgical Services and Intensive Care, Stockholm, Sweden (AO), Queen Mary University of London and Adult Critical Care Unit, Royal London Hospital (RMP), Department of Intensive Care Medicine, St George's Healthcare NHS Trust, London, UK (AR), Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (HS-L), and Institute of Clinical Sciences Malmö, Lund University, and the Department of Anaesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden (MSC).
Background:
The European Surgical Outcomes Study (EuSOS) revealed large variations in outcomes among countries. In-hospital mortality and ICU admission rates in Sweden were low, going against the assumption that access to ICU improves outcome. Long-term mortality was not reported in EuSOS and is generally poorly described in the current literature.
Objective:
To describe the characteristics of the Swedish subset of EuSOS and identify predictors of short and long-term mortality after surgery.
Design:
An observational cohort study.
Setting:
Six universities and two regional hospitals in Sweden.
Patients:
A cohort of 1314 adult patients scheduled for surgery between 4 April and 11 April 2011.
Main Outcome Measures:
30-day and 1-year mortality.
Results:
A total of 303 patients were lost to follow-up, leaving 1011 for analysis; 69% of patients were classified as American Society of Anesthesiologists' physical status 1 or 2, and 68% of surgical procedures were elective. The median length of stay in postanaesthesia care units (PACUs) was 175 min (interquartile range 110-270); 6.6% of patients had PACU length of stay of more than 12 h and 3.6% of patients were admitted to the ICU postoperatively. Thirty-day mortality rate was 1.8% [95% confidence interval (CI) 1.0-2.6] and 8.5% (CI 6.8-10.2) at 1 year (n = 18 and 86). The risk of death was higher than in an age and sex-matched population after 30 days (standardised mortality ratio 10.0, CI 5.9-15.8), and remained high after 1 year (standardised mortality ratio 3.9, CI 3.1-4.8). Factors predictive of 30-day mortality were age, American Society of Anesthesiologists' physical status, number of comorbidities, urgency of surgery and ICU admission. For 1-year mortality, age, number of comorbidities and urgency of surgery were independently predictive. ICU admission and long stay in PACU were not significant predictors of long-term mortality.
Conclusion:
Mortality rate increased almost five-fold at 1 year compared with 30-day mortality after surgery, demonstrating a significantly sustained long-term risk of death in this surgical population. In Sweden, factors associated with long-term postoperative mortality were age, number of comorbidities and surgical urgency.
