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Cited by 16Cardiac, Anesthesia and Surgical OutcomesFrailty in Older AdultsTotal Knee Arthroplasty Outcomes

The impact of functional dependence and related surgical complications on postoperative mortality

Open access
Clifton, Jacob C., Engoren, Milo, Shotwell, Matthew S., Martin, Barbara J., Clemens, Elise M., Guillamondegui, Oscar D., Freundlich, Robert E.·2022·Journal of Medical Systems
DOI 10.1007/s10916-021-01779-8PMC PMC8709534
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Abstract

Purpose Functional dependency is a known determinant of surgical risk. To enhance our understanding of the relationship between dependency and adverse surgical outcomes, we studied how postoperative mortality following a surgical complication was impacted by preoperative functional dependency. Methods We explored a historical cohort of 6,483,387 surgical patients within the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). All patients ≥ 18 years old within the ACS-NSQIP from 2007 to 2017 were included. Results There were 6,222,611 (96.5%) functionally independent, 176,308 (2.7%) partially dependent, and 47,428 (0.7%) totally dependent patients. Within 30 days postoperatively, 57,652 (0.9%) independent, 15,075 (8.6%) partially dependent, and 10,168 (21.4%) totally dependent patients died. After adjusting for confounders, increasing functional dependency was associated with increased odds of mortality (Partially Dependent OR: 1.72, 99% CI: 1.66 to 1.77; Totally Dependent OR: 2.26, 99% CI: 2.15 to 2.37). Dependency also significantly impacted mortality following a complication; however, independent patients usually experienced much stronger increases in the odds of mortality. There were six complications not associated with increased odds of mortality. Model diagnostics show our model was able to distinguish between patients who did and did not suffer 30-day postoperative mortality nearly 96.7% of the time. Conclusions Within our cohort, dependent surgical patients had higher rates of comorbidities, complications, and odds of 30-day mortality. Preoperative functional status significantly impacted the level of postoperative mortality following a complication, but independent patients were most affected.

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Authors
Clifton, J. C., Engoren, M., Shotwell, M. S., Martin, B. J., Clemens, E. M., Guillamondegui, O. D., & Freundlich, R. E.
Affiliations
  • Vanderbilt University Medical Center (US)
  • University of Michigan (US)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Clifton, Jacob C.
ORCID
Venue
Journal of Medical Systems
Publisher
Springer Science and Business Media LLC
Published
2021-11-25
Volume
46
Issue
1
Pages
6-6
ISSN
  • 0148-5598 (ISSN-L)
  • 1573-689X
DOI
10.1007/s10916-021-01779-8
PMC
PMC8709534
OpenAlex
W3216360311
Cited by
16
References
45
Citations by year
2026: 5 · 2025: 4 · 2024: 4 · 2023: 1 · 2022: 2
FWCI
1.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Medical Systems (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
national heart, lung, and blood institute (K23HL148640)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
Keywords
functional dependencies, preoperative functional status, postoperative mortality, surgical complications, 30-day mortality, surgical risk, comorbidities, National Surgical Quality Improvement Program
MeSH terms
Functional Status, Adolescent, Humans, Postoperative Complications, Retrospective Studies, Risk Factors, Cohort Studies, Comorbidity, Quality Improvement

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