Postoperative mortality in a University department of general surgery: incidence of cardiac deaths.

Objectives: To evaluate the incidence of cardiac deaths following noncardia c nonvascular surgery. Study design: Retrospective survey. Patients: All patients undergoing mainly endocrinous and digestive surgery in a University department of general surgery between 1991 and 1996. Methods: Analysis of all deaths occurring intra- and postoperatively until discharge of the patients. Demographic and medical data, including patent m yocardial ischaemia and risk factors for coronary artery disease, were reco rded and compared with a control group including all patients undergoing su rgery from January to September 1996. Results: In the 8,700 patients who underwent mainly endocrine neck surgery (66%), or intra-abdominal surgery (31%), the mortality rate (n = 96) was 1. 1% (95% confidence interval [95% CI] = 0.9-1.3%). Patent myocardial ischaem ia or high risk factors for coronary artery disease were existing in 24% of patients with neck surgery, 31% of those with intra-abdominal surgery, and in 60% of the deceased patients (P < 0.01 vs control group). Those who die d were older, were in a higher ASA physical class, and had undergone an eme rgency procedure more often than patients of the central group (P < 0.002 f or each parameter). Two cardiac deaths, in patients with a patent cardiopat hy, were recorded (cardiac mortality: 0.02%; 95% CI = 0.003-0.08%). The mai n cause of death was infection (n = 46), followed by haemorrhage (n = 12). Seven deaths remained unexplained. Conclusion: This study suggests that cardiac morbidity is a rare cause of d eath after noncardiac nonvascular surgery. (C) 2000 Editions scientifiques et medicales Elsevier SAS.