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World Journal of Surgery
Erschienen in:

28.07.2017 | Original Scientific Report

Two-way Interaction Effects of Perioperative Complications on 30-Day Mortality in General Surgery

verfasst von: Minjae Kim, Guohua Li

Erschienen in: World Journal of Surgery | Ausgabe 1/2018

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Abstract

Background

Multiple perioperative complications increase mortality risk, and certain complications synergistically increase this risk to a greater degree than might be expected if the complications were independent, but these effects are not well established.

Methods

This is a retrospective cohort study of 422,827 intraabdominal general surgery patients (American College of Surgeons National Surgical Quality Improvement Program 2005–2011). Eight complications were evaluated: acute respiratory failure (ARF), acute kidney injury (AKI), sepsis/septic shock, stroke, cardiac arrest (CA), myocardial infarction (MI), deep vein thrombosis/pulmonary embolus, and transfusion. Each combination of two complications (28 total) was modeled using a Cox model for 30-day mortality, with adjustment for preoperative comorbidities and risk factors. Additive interaction was determined with the relative excess risk due to interaction (RERI). A positive RERI indicates that the mortality risk with both complications is greater than the sum of the individual mortality risks. Bonferroni correction was applied (α = 0.05/28 = 0.0018).

Results

Seven combinations demonstrated positive interaction: sepsis-CA (RERI 88.1; p < 0.0001), ARF–AKI (RERI 50.5; p < 0.0001), AKI–sepsis (RERI 33.9; p < 0.0001), sepsis–stroke (RERI 33.9; p < 0.0001), ARF–stroke (RERI 32.3; p < 0.0001), AKI–MI (RERI 24.5; p = 0.0013), and ARF–sepsis (RERI 19.2; p < 0.0001). Two combinations demonstrated negative interaction: ARF–CA (RERI −65.1; p = 0.0017) and CA-transfusion (RERI −52.0, p < 0.0001).

Conclusions

Interaction effects exist between certain complications to increase the risk of short-term mortality. ARF, AKI, sepsis, and stroke were most likely to be involved in positive interactions. Further research into the mechanisms for these effects will be necessary to develop strategies to minimize the compounding effects of multiple complications in the perioperative period.
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Fußnoten
1
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
 
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Metadaten
Titel
Two-way Interaction Effects of Perioperative Complications on 30-Day Mortality in General Surgery
verfasst von
Minjae Kim
Guohua Li
Publikationsdatum
28.07.2017
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 1/2018
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4156-7

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