Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospit
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ORIGINAL SCIENTIFIC REPORT
Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations Magdalena Walicka1 • Agnieszka Tuszyn´ska1 • Marcin Chlebus2 • Yaroslav Sanchak3 • Andrzej S´liwczyn´ski4 • Melania Brzozowska4 • Daniel Rutkowski4 • Monika Puzianowska-Kuz´nicka5,6 • Edward Franek1,5
Accepted: 15 October 2020 Ó The Author(s) 2020
Abstract Background Identifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients. Materials and methods This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission. Results The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p \ 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The ‘‘weekend’’ effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission. Conclusion Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.
& Edward Franek [email protected] 1
Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital MSWiA, ul. Woloska 137, 02-507 Warsaw, Poland
2
Department of Quantitative Finance, Faculty of Economic Sciences, University of Warsaw, ul. Dluga 44/50, 00-241 Warsaw, Poland
3
Warsaw Medical University, ul. Zwirki i Wigury 61, 02-091 Warsaw, Poland
4
National Health Fund, ul. Grojecka 186, 02-390 Warsaw, Poland
5
Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, ul. Pawinskiego 5, 02-106 Warsaw, Poland
6
Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, Ceglowska 80, 01-809 Warsaw, Poland
123
World J Surg
Introduction The number of surgical interventions is increasing. Weisser et al. approximated that around 312.9 million surgical procedures occurred in 2012, equating to an increase of about one third over an 8 year period [1]. Although surgical care prevents many deaths, complic
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