• Nadine Wickboldt, Guy Haller, Cecile Delhumeau, and Bernhard Walder.
• Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Clinical Pharmacology, University Hospitals of Geneva, Switzerland.
• Swiss Med Wkly. 2015 Jan 1; 145: w14205.

Questions Under Study/PrinciplesThe objective was to assess observed-to-expected in-hospital postoperative 30-day mortality and to identify associated risks.MethodsA single centre, retrospective study was performed in Geneva University Hospitals, Switzerland. Hospitalised adult surgical patients who received anaesthesia and stayed in the Post Anaesthesia Care Unit - Intermediate Care Unit (PACU-IMC) between July 2008 and June 2011 were included. Outcome measure was in-hospital 30-day mortality. Expected probabilities of in-hospital death were estimated with the surgical mortality probability model (S-MPM). Descriptive statistics were calculated. Univariate and multivariate logistic regressions (odds ratio [OR] with 95% confidence interval [95% CI]) were used to identify risk factors of mortality.ResultsOverall in-hospital mortality was 0.8% (176/24 160 patients). Observed 30-day in-hospital mortality was 0.7%; expected mortality from the S-MPM was 1.2%. Independent risk factors were age (OR 1.05, 95% CI 1.03-1.06), American Society of Anesthesiologists Physical Status score (ASA PS 3-5 vs ASA PS 1-2: OR 5.48, 95% CI 3.12-9.63), nonelective surgery (vs elective surgery) (OR 3.15, 95% CI 2.04-4.86), head surgery (OR 2.83, 95% CI 1.41-5.67) and duration of PACU-IMC stay (OR 1.00, 95% CI 1.00-1.00). A protective factor was a high body mass index (OR 0.92, 95% CI 0.89-0.96). The procedural risk, type and time of anaesthesia and day of intervention were not independent risk factors of mortality.ConclusionThe postoperative observed-to-expected mortality ratio was favourable. Independent postoperative risk factors for mortality were well-established factors such as age, ASA PS, non elective surgery but also duration of PACU-IMC stay which was considered as a surrogate of postoperative complications.

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