Outcomes of abdominal surgery in patients receiving mechanical ventilation for more than 48 hours

Abdominal surgery in critically ill patients has high mortality, contributing to high US healthcare costs. This study sought to identify specific predictors of mortality in this population.

Using the National Surgical Quality Improvement Program database 2006 to 2012, we identified 4,901 patients who were intubated for more than 48 hours before undergoing common abdominal procedures. Mortality and predictors of mortality were determined using chi-square and/or regression analysis.

Overall 30-day mortality was 44.2% with increasing mortality for additional procedures performed. Ventilated patients with the following preoperative risk factors were 2 to 3 times as likely to die within 30 days of surgery: age greater than 65-years old, coma, preoperative international normalized ratio greater than 3.0, esophageal varices, and disseminated cancer.

Mortality is significant in ventilated patients who undergo abdominal surgery and is especially high with advanced age, disseminated cancer, and complications of liver disease. Physicians should carefully discuss this with patients and/or family and consider palliative options when appropriate.