Clinical ScienceOutcomes of abdominal surgery in patients receiving mechanical ventilation for more than 48 hours

•Abdominal surgery in critically ill patients has high mortality and high costs.•Using the National Surgical Quality Improvement Program database, mortality, and predictors of mortality were determined.•Overall 30-day mortality was 44.2%, increasing with additional procedures performed.•Risk factors include advanced age, disseminated cancer, and advanced liver disease.

BackgroundAbdominal surgery in critically ill patients has high mortality, contributing to high US healthcare costs. This study sought to identify specific predictors of mortality in this population.MethodsUsing the National Surgical Quality Improvement Program database 2006 to 2012, we identified 4,901 patients who were intubated for more than 48 hours before undergoing common abdominal procedures. Mortality and predictors of mortality were determined using chi-square and/or regression analysis.ResultsOverall 30-day mortality was 44.2% with increasing mortality for additional procedures performed. Ventilated patients with the following preoperative risk factors were 2 to 3 times as likely to die within 30 days of surgery: age greater than 65-years old, coma, preoperative international normalized ratio greater than 3.0, esophageal varices, and disseminated cancer.ConclusionsMortality is significant in ventilated patients who undergo abdominal surgery and is especially high with advanced age, disseminated cancer, and complications of liver disease. Physicians should carefully discuss this with patients and/or family and consider palliative options when appropriate.