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Postoperative Complications Affecting Survival After Cardiac Arrest in General Surgery Patients

Kim, Minjae MD, MS*†; Li, Guohua MD, DrPH*†

doi: 10.1213/ANE.0000000000002460
Patient Safety: Original Clinical Research Report

BACKGROUND: Postoperative cardiac arrest is uncommon but associated with a high mortality risk in general surgery patients and is often preceded by postoperative complications. The relationships between previous complications and mortality after cardiac arrest in general surgery patients have not been completely evaluated.

METHODS: A retrospective, observational cohort of general surgery in patients with cardiac arrest occurring after postoperative day (POD) #0 (and up to POD #30) was obtained from the 2012–2013 American College of Surgeons National Surgical Quality Improvement Program. Previous complication was defined as at least one of the following occurring before the POD of cardiac arrest: (1) acute kidney injury; (2) acute respiratory failure; (3) deep vein thrombosis/pulmonary embolus; (4) myocardial infarction; (5) sepsis/septic shock; (6) stroke; and/or (7) transfusion. The associations between previous complications and mortality after cardiac arrest were assessed using Cox proportional hazards models that adjusted for preoperative risk factors.

RESULTS: Of 1352 patients with postoperative cardiac arrest, 746 patients (55%) developed at least 1 complication before cardiac arrest. Overall 30-day mortality was 71% (958/1352) and was similar among patients with and without a previous complication (71% [533/746] vs 70% [425/606]; P = .60). Patients with previous complications did not have an increased risk of mortality, compared to patients without previous complications, in adjusted Cox models (hazard ratio, 1.03; 95% confidence interval, 0.90–1.18; P = .70). In addition, no previous complication was associated with increased mortality risk in individual analyses.

CONCLUSIONS: Among general surgery patients with cardiac arrest after POD #0, complications occurring before cardiac arrest are common but are not associated with increased mortality risk.

From the *Department of Anesthesiology, Columbia University Medical Center, New York, New York; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Published ahead of print September 7, 2017.

Accepted for publication July 25, 2017.

Funding: Supported in part by a Mentored Research Award from the International Anesthesia Research Society, San Francisco, CA (M.K.), and grant No. R49 CE002096 from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA (G.L.). Its contents are solely the responsibility of the authors and do not necessarily reflect the official views of the funding agencies.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

This study was presented in part at the American Society of Anesthesiologists’ Annual Meeting, Chicago, IL, October 2016.

Reprints will not be available from the authors.

Address correspondence to Minjae Kim, MD, MS, Department of Anesthesiology, Columbia University Medical Center, 622 W 168th St, PH 5, Suite 505C, New York, NY 10032. Address e-mail to

© 2018 International Anesthesia Research Society