Postoperative Outcomes Following Elective Surgery in India

Vandana Agarwal; Radhakrishnan Muthuchellappan; Bhagyesh A Shah; Pallavi P Rane; Atul P Kulkarni

doi:10.5005/jp-journals-10071-23807

Postoperative Outcomes Following Elective Surgery in India

Indian J Crit Care Med. 2021 May;25(5):528-534. doi: 10.5005/jp-journals-10071-23807.

Authors

Vandana Agarwal¹, Radhakrishnan Muthuchellappan², Bhagyesh A Shah³, Pallavi P Rane⁴, Atul P Kulkarni¹

Affiliations

¹ Department of Anaesthesia, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
² Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
³ Department of Intensive Care Medicine, CIMS Hospital, Care Institute of Medical Sciences, Ahmedabad, Gujarat, India.
⁴ Clinical Research Secretariat, Tata Memorial Centre, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Navi Mumbai, Maharashtra, India.

Abstract

Introduction: The incidence of complications and mortality in patients undergoing elective surgery in India are unknown. We contributed Indian data to ISOS. Since there were fewer than ten centers, Indian data were not included in the primary analysis. We report postoperative outcomes in the Indian data set of patients following elective surgery.

Materials and methods: In this prospective 7-day observational study, after obtaining a waiver of informed consent, data were collected for 30 days from consecutive patients >18 years undergoing elective surgery. The primary outcome was in-hospital postoperative complications. The secondary outcomes were in-hospital all-cause mortality, the relationship between postoperative complications and admission to critical care, and the duration of hospital stay. Complications were graded as mild, moderate, and severe. Failure to rescue was defined as mortality in patients admitted to an intensive care unit (ICU) for the treatment of complications.

Results: Complications occurred in 57 (27.5%) patients, who were older (53 vs 47 years, p < 0.001) and had American Society of Anaesthesiologists grades III and IV physical status (p = 0.029). One hundred and thirty-eight (65.7%) patients underwent a major surgical procedure of which 132 (62.8%) procedures were done for malignancy. Postoperative complications were significantly higher (41.5% vs 22.7%) in patients electively admitted to ICU. The overall mortality rate was 2.4%, whereas the mortality rate was 8.8% in those who developed complications.

Conclusion: We found that 28% of patients developed postoperative complications. The overall mortality was 2.4% but was higher (8.8%) in those who developed complications. Age and complex surgical procedures independently predicted complications, while lower preoperative hemoglobin appeared to be protective.

Study registration: ISRCTN51817007.

How to cite this article: Agarwal V, Muthuchellappan R, Shah BA,Rane PP, Kulkarni AP, et al. Postoperative Outcomes Following Elective Surgery in India. Indian J Crit Care Med 2021;25(5):528-534.

Keywords: American Society of Anaesthesiologists physical status; Elective surgery; Failure to rescue; Indian dataset of ISOS study; International Surgical Outcomes Study; Postoperative complications; Postoperative mortality; Postoperative outcomes.