Risk factors of hospitalisation in general surgery units: new application of International Classification of Diseases

Introduction

The authors decided to estimate the risk of death for patients admitted to general surgery units dependent on the suggested risk factor comprised in the description of basic diagnosis (according to International Classification of Diseases (ICD-10)).

Methods

The study was a retrospective analysis of mortality in general surgery units located at three university hospitals: N. Barlicki University Hospital No. 1 in Lodz, WAM University Hospital No. 2 in Lodz and B. Szarecki University Hospital No. 5. The study comprised 26,020 patients treated in these units from 1 January 2003 to 31 December 2006. One of the distinguished death risk factors – malignant neoplasm, suspicion of malignant neoplasm, acute diffuse peritonitis, paralytic ileus, acute pancreatitis, other inflammatory conditions, bleeding from digestive tract, acute vascular disorders of intestines (included in basic diagnosis), states with peritoneal obliteration, perforation or peritonitis (included in basic diagnosis), states with acute hepatic failure or cirrhosis (included into basic diagnosis) or lack of death risk factor – is ascribed to each basic diagnosis of patients hospitalised in one of the selected units (after modification of the structure). The death risk groups formed in this way were subjected to further statistical analysis in order to estimate the occurrence of significant differences in mortality between the group without the risk factor and the groups containing determined risk factors.

Results

Among the risk factors subjected to analysis, only one (malignant neoplasm) demonstrated a significant difference in mortality in relation to the group of diagnoses without a risk factor in every general surgery unit subjected to analysis. Three risk factors (paralytic ileus, acute vascular disorders of intestines, states with peritoneal obliteration, perforation or peritonitis) manifested a significant difference in mortality in relation to the group of diagnoses without a risk factor in one of the three surgical units subjected to analysis.

Conclusion

1. A patient hospitalised in a general surgery unit with basic diagnosis (according to ICD-10) comprising malignant neoplasm is a patient at increased risk of death (high-risk factor). 2. A patient hospitalised with basic diagnosis comprising paralytic ileus, acute vascular disorders of intestines or states with peritoneal obliteration, perforation or peritonitis is a patient with moderately increased risk of death (low-risk factor). 3. A patient hospitalised with basic diagnosis comprising acute diffuse peritonitis and the states with acute hepatic failure or cirrhosis requires further studies (necessity for increase of the sample size).