Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP.

Journal Article

OBJECTIVES: To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR). DESIGN: Retrospective cohort study. SETTING: American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2010. MAIN OUTCOME MEASURES: Incidence of CPR, complications, mortality, and survival to hospital discharge at 30 days or less after surgery. RESULTS: A total of 6382 nontrauma patients (mean age, 68 years) underwent CPR; 85.9% of events occurred postoperatively, of which 49.8% occurred within 5 days after surgery. Overall incidence of CPR was 1 in 203 surgical cases but varied by specialty (1 in 33 for cardiac surgery vs 1 in 258 for general surgery). The mortality rates varied by specialty (45.0%-74.5%) and were associated with comorbidity burden (58.7% for no comorbidity, 63.1% for 1 comorbidity, and 72.8% for ≥2 comorbidities; P < .001). A total of 77.6% of CPR patients experienced a complication; approximately 75.0% occurred before or on the day of CPR, and septicemia (26.7%), ventilator dependence (22.1%), significant bleeding (13.9%), and renal impairment (11.9%) were the most common. The overall 30-day mortality was 71.6%. Survival to discharge in 30 postoperative days or less was 19.2%; 9.2% of CPR patients were alive but hospitalized at postoperative day 30. Older age, a preexisting do-not-resuscitate order, renal impairment, disseminated cancer, preoperative sepsis, and postoperative arrest were among the factors independently associated with worse survival. CONCLUSIONS: One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients.

Full Text

Duke Authors

Cited Authors

  • Kazaure, HS; Roman, SA; Rosenthal, RA; Sosa, JA

Published Date

  • January 2013

Published In

Volume / Issue

  • 148 / 1

Start / End Page

  • 14 - 21

PubMed ID

  • 23324834

Electronic International Standard Serial Number (EISSN)

  • 2168-6262

International Standard Serial Number (ISSN)

  • 2168-6254

Digital Object Identifier (DOI)

  • 10.1001/jamasurg.2013.671

Language

  • eng