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      Leading Comorbidity associated with 30-day post-anesthetic mortality in geriatric surgical patients in Taiwan: a retrospective study from the health insurance data

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          Abstract

          Background

          Elderly patients with aged physical status and increased underlying disease suffered from more postoperative complication and mortality. We design this retrospective cohort study to investigate the relationship between existing comorbidity of elder patients and 30 day post-anesthetic mortality by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) from Health Insurance Database.

          Methods

          Patients aged above 65 years old who received anesthesia between 2000 and 2010 were included from 1 million Longitudinal Health Insurance Database in (LHID) 2005 in Taiwan. We use age, sex, type of surgery to calculate propensity score and match death group and survival one with 1:4 ratio (death: survival = 1401: 5823). Multivariate logistic model with stepwise variable selection was employed to investigate the factors affecting death 30 days after anesthesia.

          Results

          Thirty seven comorbidities can independently predict the post-anesthetic mortality. In our study, the leading comorbidities predict post-anesthetic mortality is chronic renal disease (OR = 2.806), acute myocardial infarction (OR = 4.58), and intracranial hemorrhage (OR = 3.758).

          Conclusions

          In this study, we present the leading comorbidity contributing to the postoperative mortality in elderly patients in Taiwan from National Health Insurance Database. Chronic renal failure is the leading contributing comorbidity of 30 days mortality after anesthesia in Taiwan which can be explained by the great number of hemodialysis and prolong life span under National Taiwan Health Insurance. Large scale database can offer enormous information which can help to improve quality of medical care.

          Electronic supplementary material

          The online version of this article (10.1186/s12877-017-0629-7) contains supplementary material, which is available to authorized users.

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          Most cited references24

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          Surgical risk factors, morbidity, and mortality in elderly patients.

          Florence E Turrentine, Hongkun Wang, Virginia B Simpson … (2006)
          The aging population of the United States results in increasing numbers of surgical operations on elderly patients. This study observed aging related to morbidity, mortality, and their risk factors in patients undergoing major operations. We reviewed our institution's American College of Surgeons National Surgical Quality Improvement Program database from February 24, 2002, through June 30, 2005, including standardized preoperative, intraoperative, and 30-day postoperative data points. This required review and analysis of the prospectively collected data. We examined patient demographics, preoperative risk factors, intraoperative risk factors, and 30-day outcomes with a focus on those aged 80 years and older. A total of 7,696 surgical procedures incurred a 28% morbidity rate and 2.3% mortality rate, although those older than 80 years of age had a morbidity of 51% and mortality of 7%. Hypertension and dyspnea were the most frequent risk factors in those aged 80 years and older. Preoperative transfusion, emergency operation, and weight loss best predicted morbidity for those 80 years of age and older. Operative duration predicted "other" postoperative occurrences and emergent case status predicted respiratory occurrences across all age groups. Preoperative impairment of activities of daily living, emergency operation, and increased American Society of Anesthesiology classification predicted mortality across all age groups. A 30-minute increment of operative duration increased the odds of mortality by 17% in patients older than 80 years. Postoperative morbidity and mortality increased progressively with increasing age. Age was statistically significantly associated with morbidity (wound, p = 0.021; renal, p = 0.001; cardiovascular, p = 0.0004; respiratory, p < 0.0001) and mortality (p = 0.001). Although several risk factors for postoperative morbidity and mortality increase with age, increasing age itself remains an important risk factor for postoperative morbidity and mortality.
          Article 0 comments Cited 250 times – based on 0 reviews     Review now
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            ASA class is a reliable independent predictor of medical complications and mortality following surgery.

            Nicholas Hackett, Gildasio S. De Oliveira, Umang K Jain … (2015)
            The American Society of Anesthesiologists Physical Status classification system (ASA PS) is a method of characterizing patient operative risk on a scale of 1-5, where 1 is normal health and 5 is moribund. Every anesthesiologist is trained in this measure, and it is performed before every procedure in which a patient undergoes anesthesia. We measured the independent predictive value of ASA-PS for complications and mortality in the ACS-NSQIP database by multivariate regression. We conducted analogous regressions after standardizing ASA-PS to control for interprocedural variations in risk in the overall model and sub-analyses by surgical specialty and the most common procedures.
            Article 0 comments Cited 145 times – based on 0 reviews     Review now
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              Association of nucleos(t)ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide cohort study.

              Chun-Ying Wu, Jaw-Town Lin, Hsiu Ho … (2014)
              Treatment for hepatitis B virus infection reduces the risk of hepatocellular carcinoma (HCC). However, the long-term protective effects for subgroups of patients with chronic hepatitis B are unclear. We conducted a retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database (from January 1, 1997, through December 31, 2010). Cumulative incidences were calculated and multivariable analyses were carried out after adjusting for competing mortality. Propensity scores were used to match 21,595 patients with chronic hepatitis B who received nucleoside analogue therapy for at least 90 days (treated cohort) with 21,595 untreated patients with chronic hepatitis B (controls), who received hepatoprotectants for at least 90 days. Data were collected from the treated cohort for a mean period of 3.46 years and from controls for 5.24 years. The treated cohort had a significantly lower 7-year incidence of HCC (7.32%; 95% confidence interval [CI], 6.77%-7.87%) than controls (22.7%; 95% CI, 22.1%-23.3%; P < .001). After adjusting for competing mortality and other confounders, nucleos(t)ide analogue treatment was associated with a reduced risk of HCC, with an adjusted hazard ratio of 0.37 (95% CI, 0.34-0.39; P < .001). Sensitivity analyses confirmed the association between nucleos(t)ide analogue treatment and reduced risk of HCC. Age, sex, cirrhosis, and diabetes mellitus modified this association. Based on a retrospective, nationwide study in Taiwan, nucleoside analogue therapy use is associated with reduced risk of HCC in patients with chronic hepatitis B virus infection. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Chun-Lin Chu: cclgenie@yahoo.com.tw
                Hung-Yi Chiou: hychiou@tmu.edu.tw
                Wei-Han Chou: brokenarrowchou@hotmail.com
                Po-Ya Chang: rj0729@hotmail.com
                Yi-You Huang: yyhuang@ntu.edu.tw
                Huei-Ming Yeh: 886-2-2312-3456 , y.y.hhmm@hotmail.com
                Journal
                Journal ID (nlm-ta): BMC Geriatr
                Journal ID (iso-abbrev): BMC Geriatr
                Title: BMC Geriatrics
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2318
                Publication date (Electronic): 24 October 2017
                Publication date PMC-release: 24 October 2017
                Publication date Collection: 2017
                Volume: 17
                Electronic Location Identifier: 245
                Affiliations
                [1 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, Institute of Biomedical Engineering National Taiwan University, ; No1, Sec 1, Jen-Ai Rd., Taipei, Taiwan
                [2 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, Department of Anesthesiology, , National Taiwan University Hospital Yun-Lin Branch, ; No 579, Sec 2, Yun-Lin Rd., Douliu, Yun-Lin Taiwan
                [3 ]ISNI 0000 0000 9337 0481, GRID grid.412896.0, School of Public Health, , Taipei Medical University, ; No 250, Wu-Shin Street, Taipei, Taiwan
                [4 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, Department of Anesthesiology, , National Taiwan University Hospital, ; No 7 Chung-Shan South Road, Taipei, Taiwan, Republic of China
                Article
                Publisher ID: 629
                DOI: 10.1186/s12877-017-0629-7
                PMC ID: 5654003
                PubMed ID: 28049446
                SO-VID: 9ae4cf3f-b50f-42ed-84e5-e06c876b2e03
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 28 March 2017
                Date accepted : 8 October 2017
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Geriatric medicine
                Keywords: comorbidity,post-anesthesia mortality
                Data availability:
                ScienceOpen disciplines: Geriatric medicine
                Keywords: comorbidity, post-anesthesia mortality

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