BACKGROUND While short-term perioperative outcomes have been well studied in Western surgical populations, the aim of this study is to look at the one-year perioperative mortality and its associated factors in an Asian surgical population after non-cardiac surgery. METHODS A retrospective cohort study of 2163 patients aged above 45 undergoing non-cardiac surgery in a university-affiliated tertiary hospital from January to July 2015 was performed. Relevant demographic, clinical and surgical data were analysed to elicit their relationship to mortality at one year after surgery. A univariate analysis was first performed to identify significant variables with p-values ≤ 0.2, which were then analysed using Firth multiple logistic regression to calculate the adjusted odds ratio. RESULTS The one-year mortality in our surgical population was 5.9%. The significant factors that increased one-year mortality include smoking (adjusted OR 2.17 (1.02-4.45), p = 0.044), anaemia (adjusted OR 1.32 (1.16-1.47), p < 0.001, for every 1 g/dL drop in haemoglobin level), lower BMI (adjusted OR 0.93 (0.87-0.98), p = 0.005, for every 1 point increase in BMI), Malay and Indian ethnicity (adjusted OR 2.68 (1.53-4.65), p = 0.001), peripheral vascular disease (adjusted OR 4.21 (1.62-10.38), p = 0.004), advanced age (adjusted OR 1.04 (1.01-1.06), p = 0.004, for every one year increase in age), emergency surgery (adjusted OR 2.26 (1.29-3.15), p = 0.005) and malignancy (adjusted OR 3.20 (1.85-5.52), p < 0.001). CONCLUSIONS Our study shows that modifiable risk factors such as malnutrition, anaemia and smoking which affect short term mortality extend beyond the immediate perioperative period into longer term outcomes. Identification and optimization of this subset of patients are therefore vital. Further similar large studies should be done to develop a risk scoring system for post-operative long-term outcomes. This would aid clinicians in risk stratification, counselling and surgical planning, which will help in patients' decision making and care planning.

中文翻译：

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一项回顾性队列研究表明，预测接受中度至重大非心脏手术的亚洲老年患者一年手术后死亡率的因素。

背景技术虽然在西方外科手术人群中已对短期围手术期结局进行了很好的研究，但本研究的目的是研究非心脏手术后亚洲外科手术人群的一年围手术期死亡率及其相关因素。方法一项回顾性队列研究于2015年1月至2015年7月在大学附属三级医院进行了2163例45岁以上的非心脏手术患者。分析了相关的人口统计学，临床和外科手术数据，以得出它们与术后一年死亡率的关系。首先进行单变量分析以识别p值≤0.2的显着变量，然后使用Firth多元logistic回归进行分析以计算调整后的优势比。结果我们手术人群的一年死亡率为5.9％。每增加1 g / dL血红蛋白，吸烟者（调整后的OR为2.17（1.02-4.45），p = 0.044），贫血（调整后的OR为1.32（1.16-1.47），p <0.001，p <0.001）会导致一年死亡率的增加水平），较低的BMI（调整后的OR为0.93（0.87-0.98），p = 0.005，每增加1点BMI），马来人和印度裔种族（调整后的OR为2.68（1.53-4.65），p = 0.001），周围血管疾病（调整后的OR为4.21（1.62-10.38），p = 0.004），高龄（调整后的OR为1.04（1.01-1.06），p = 0.004，每增加一年的年龄），急诊手术（调整后的OR 2.26（1.29-3.15） ），p = 0.005）和恶性肿瘤（调整后为OR 3.20（1.85-5.52），p <0.001）。结论我们的研究表明，诸如营养不良，影响短期死亡率的贫血和吸烟已超出围手术期的长期范围，直至长期结果。因此，识别和优化这部分患者至关重要。应该进行进一步的类似大型研究，以开发术后长期预后的风险评分系统。这将有助于临床医生进行风险分层，咨询和手术计划，这将有助于患者的决策和护理计划。