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Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years.

Patient Acuity and Operative Technique Associated with Post-Colectomy Mortality Across New York State: an Analysis of 160,792 Patients over 20 years.
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Lamm R, Mathews SN, Yang J, Park J, Talamini M, Pryor AD, Telem D,


Lamm R, Mathews SN, Yang J, Park J, Talamini M, Pryor AD, Telem D, (click to view)

Lamm R, Mathews SN, Yang J, Park J, Talamini M, Pryor AD, Telem D,

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Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2017 03 15() doi 10.1007/s11605-017-3393-2
Abstract

This study sought to characterize in-hospital post-colectomy mortality in New York State. One hundred sixty thousand seven hundred ninety-two patients who underwent colectomy from 1995 to 2014 were analyzed from the all-payer New York Statewide Planning and Research Cooperative System (SPARCS) database. Linear trends of in-hospital mortality rate over 20 years were calculated using log-linear regression models. Chi-square tests were used to compare categorical variables between patients. Multivariable regression models were further used to calculate risk of in-hospital mortality associated with specific demographics, co-morbidities, and perioperative complications. From 1995 to 2014, 7308 (4.5%) in-hospital mortalities occurred within 30 days of surgery. Over this time period, the rate of overall in-hospital post-colectomy mortality decreased by 3.3% (6.3 to 3%, p < 0.0001). The risk of in-hospital mortality for patients receiving emergent and elective surgery decreased by 1% (RR 0.99 [0.98-1.00], p = 0.0005) and 5% (RR 0.95 [0.94-0.96], p < 0.0001) each year, respectively. Patients who underwent open surgeries were more likely to experience in-hospital mortality (adjusted OR 3.65 [3.16-4.21], p < 0.0001), with an increased risk of in-hospital mortality each year (RR 1.01 [1.00-1.03], p = 0.0387). Numerous other risk factors were identified. In-hospital post-colectomy mortality decreased at a slower rate in emergent versus elective surgeries. The risk of in-hospital mortality has increased in open colectomies.

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