• C-W Lim, J-H Lee, S-M Im, I-K Song, H-P Park, H-S Kim, and J-T Kim.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
• Acta Anaesthesiol Scand. 2016 Apr 1; 60 (4): 432-40.

BackgroundThe purpose of this study was to determine causes and characteristics of early postoperative mortality focusing on postoperative day 1 (POD 1).MethodsWe reviewed the electronic medical records of patients who died within 7 days after surgery under anesthesia at a tertiary university hospital from January 2004 to December 2014. Postoperative mortalities were divided into POD 1 group and POD 7 group, which included death that occurred from days 2 to 7 after surgery. Characteristics of POD 1 group were compared with those of POD 7 group.ResultsThe mortality rates of POD 1 and POD 7 groups were 3.6 and 7.8 per 10,000 anesthesia, respectively. The incidence of POD 1 mortality is higher than any other day of the week of surgery. The incidences of massive transfusion, intraoperative cardiac arrest, and intraoperative use of epinephrine were higher in POD 1 group than in POD 7 group. In adults, the proportion of emergency operations was higher in POD 1 group than in POD 7 group. The leading cause of death in POD 1 group was hypovolemic and cardiogenic shock, whereas that in POD 7 group was distributive shock. Human factor-related mortality was more frequent in POD 1 group (15.3%) compared with POD 7 group (6.1%).ConclusionsThe characteristics of POD 1 mortality were different from those of POD 2-7 mortality. A large proportion of early postoperative deaths were due to POD 1 mortality. Human factor-related causes were more associated with POD 1 mortality, indicating much room for improvement.© 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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