Medical versus surgical causes of death following colorectal resection: a Queensland Audit of Surgical Mortality (QASM) study

Abstract

AbstractBackgroundThe causes of death following colorectal resection remain poorly explored. Few studies have addressed whether early post‐operative mortality is predominantly caused by a patient's medical co‐morbidities, or from factors pertaining to the presenting surgical disease process itself. This study analyses data from the Queensland audit of surgical mortality (QASM) to report the causes of in‐hospital death following colorectal resection, identifies whether these were due to either medical or surgical factors, and determines the patient characteristics associated with a medical cause of death.MethodsThrough analysis of QASM Surgical Case Forms, the causes of in‐hospital death were determined in 750 patients who died in Queensland following colorectal resection between January 2010 and December 2020. Deaths were attributed to a specific medical or surgical cause, with multivariate analysis used to identify independent risk factors associated with a medical cause of death.ResultsIn total, 395 patients (52.7%) died due to surgical causes and 355 (47.3%) died due to medical causes. Respiratory co‐morbidities (OR 1.832, 95% CI: 1.267–2.650), advanced malignancy (OR 1.814, 95% CI: 1.262–2.607), neurological co‐morbidities (OR 1.794, 95% CI: 1.168–2.757) and advanced age (OR 1.430, 95% CI: 1.013–2.017) were independent risk factors associated with increased risk of a medical cause of death.ConclusionEven in the absence of complicating surgical factors, a significant number of patients died in hospital following colorectal resection due to their underlying co‐morbidities. Multi‐disciplinary models of care which allow for the early recognition and treatment of medical complications may reduce post‐operative mortality in these patients.