[Postoperative mortality in a general hospital]

To compare the postoperative mortality of our hospital to that of others.

Retrospectively, we studied patients who died after surgery in 1994, defining postoperative mortality as death occurring in the hospital after surgery. The variables studied were age, sex, preoperative disease, ASA, type of surgery, anesthetic technique, intraoperative complications and place, cause and time of death.

One hundred six (1.63%) of the 6,485 surgical patients died. The highest proportion were cardiovascular surgery patients (3.36%) and the smallest proportion (0%) had undergone eye surgery. Of patients receiving general anesthesia 2.16% died, while 0.59% of those receiving local-regional anesthesia did so. Most of those who died were male (55.66%); were over 55 years of age (87.73%); were ASA IV (67.03%); had associated medical disease (79.24%), mainly arterial hypertension; or had undergone emergency surgery (54.71%). Most who died had received general anesthesia (87.73%). Half of all deaths occurred in patients who presented some type of complication during surgery; this was the case with all who received intradural anesthesia, in 47.89% of those who had received general anesthesia and 20% of those receiving local anesthesia. The most common intraoperative complication in all anesthetic techniques was post-induction arterial hypotension. Over half of deaths occurred on the ward, after the first postoperative week, and the most frequent cause of death was sepsis (19.81%). We considered a death occurring on the hospital ward within the first 24 hours after surgery as possibly being associated with anesthesia (1.54/10,000).

Risk factors for postoperative mortality established in other studies (advanced age, male sex, emergency surgery and ASA IV-V) were relevant in most of the deaths studied. Our mortality rate is similar to that reported by other authors for the first 24 to 48 hours after surgery, but is higher 30 days after surgery and later. Some of the 13 patients who died on the hospital ward in the first 48 hours after surgery probably did not receive the care that would have been provided in the postoperative intensive care unit.