Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles

ORIGINAL RESEARCH

Postoperative Outcomes Following Elective Surgery in India

Vandana Agarwal, Radhakrishnan Muthuchellappan, Bhagyesh A Shah, Pallavi P Rane

Keywords : American Society of Anaesthesiologists physical status, Elective surgery, Failure to rescue, International Surgical Outcomes Study, Indian dataset of ISOS study, Postoperative mortality, Postoperative complications, Postoperative outcomes

Citation Information : Agarwal V, Muthuchellappan R, Shah BA, Rane PP. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021; 25 (5):528-534.

DOI: 10.5005/jp-journals-10071-23807

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis. We report postoperative outcomes in the Indian data set of patients following elective surgery. Materials and methods: In this prospective 7-day observational study, after obtaining a waiver of informed consent, data were collected for 30 days from consecutive patients >18 years undergoing elective surgery. The primary outcome was in-hospital postoperative complications. The secondary outcomes were in-hospital all-cause mortality, the relationship between postoperative complications and admission to critical care, and the duration of hospital stay. Complications were graded as mild, moderate, and severe. Failure to rescue was defined as mortality in patients admitted to an intensive care unit (ICU) for the treatment of complications. Results: Complications occurred in 57 (27.5%) patients, who were older (53 vs 47 years, p < 0.001) and had American Society of Anaesthesiologists grades III and IV physical status (p = 0.029). One hundred and thirty-eight (65.7%) patients underwent a major surgical procedure of which 132 (62.8%) procedures were done for malignancy. Postoperative complications were significantly higher (41.5% vs 22.7%) in patients electively admitted to ICU. The overall mortality rate was 2.4%, whereas the mortality rate was 8.8% in those who developed complications. Conclusion: We found that 28% of patients developed postoperative complications. The overall mortality was 2.4% but was higher (8.8%) in those who developed complications. Age and complex surgical procedures independently predicted complications, while lower preoperative hemoglobin appeared to be protective. Study Registration: ISRCTN51817007


PDF Share
  1. Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, et al. Global access to surgical care: a modelling study. Lancet Glob Health 2015;3(6):e316–e323. DOI: 10.1016/S2214-109X(15)70115-4.
  2. Dare AJ, Ng-Kamstra JS, Patra J, Fu SH, Rodriguez PS, Hsiao M, et al. Deaths from acute abdominal conditions and geographical access to surgical care in India: a nationally representative spatial analysis. Lancet Glob Health 2015;3(10):e646–e653. DOI: 10.1016/S2214-109X(15)00079-0.
  3. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012;380(9847):1059–1065. DOI: 10.1016/S0140-6736(12)61148-9.
  4. International Surgical Outcomes Study Group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth 2016;117(5):601–609. DOI: 10.1093/bja/aew316.
  5. Biccard BM, Madiba TE, Kluyts H-L, Munlemvo DM, Madzimbamuto FD, Basenero A, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet 2018;391(10130):1589–1598. DOI: 10.1016/S0140-6736(18)30001-1.
  6. Hackett NJ, De Oliveira GS, Jain UK, Kim JYS. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg 2015;18:184–190. DOI: 10.1016/j.ijsu.2015.04.079.
  7. Biccard BM, Madiba TE, Surgical Outcomes Study Investigators O Behalf of the SA. The South African Surgical Outcomes Study: a 7-day prospective observational cohort study. S Afr Med J 2015;105(6):465. DOI: 10.7196/samj.9435.
  8. Ahmad T, Bouwman RA, Grigoras I, Aldecoa C, Hofer C, Hoeft A, et al. Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery. Br J Anaesth 2017;119(2):258–266. DOI: 10.1093/bja/aex185.
  9. Leeds IL, Canner JK, Efron JE, Ahuja N, Haut ER, Wick EC, et al. The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction. J Surg Res 2017;220:402–409. DOI: 10.1016/j.jss.2017.08.039.
  10. The International Surgical Outcomes Study (ISOS) Group, Kahan BC, Koulenti D, Arvaniti K, Beavis V, Campbell D, et al. Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med 2017;43(7):971–979. DOI: 10.1007/s00134-016-4633-8.
  11. Abbott TEF, Ahmad T, Phull MK, Fowler AJ, Hewson R, Biccard BM, et al. The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis. Br J Anaesth 2018;120(1):146–155. DOI: 10.1016/j.bja.2017.08.002.
  12. Chaudery H, MacDonald N, Ahmad T, Chandra S, Tantri A, Sivasakthi V, et al. Acute kidney injury and risk of death after elective surgery: prospective analysis of data from an International Cohort Study. Anesth Analg 2019;128(5):1022–1029. DOI: 10.1213/ANE.0000000000003923.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.