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Postoperative mortality in the Netherlands: identifying high-risk surgery


Type of surgery is considered a risk factor of adverse outcome, but mortality rates of common procedures are scarce [1, 2]. The objective of the study was to further identify high-risk patients by procedure-specific mortality.


Data between 1991 and 2006 were obtained from Dutch national healthcare statistics. Patients age >20, with an elective, nonday case, open surgical procedure were enrolled. Data included main diagnosis, secondary diagnoses, dates of admission and discharge, death during admission, operations, age, gender, and co-morbidities according to ICD-9-CM. Logistic regression analyses were applied to evaluate the relationship between type of surgery and postoperative mortality.


A total of 3,667,875 surgical procedures, from 102 hospitals, were included. Postoperative death was observed in 67,879 patients (1.85%). Overall, vascular surgery had highest mortality (incidence 6.0%). Abdominal surgery was associated with 2% mortality. However, procedure-specific adjusted mortality identified spleen (adjusted OR 6.84), liver (adjusted OR 5.45), gastric (adjusted OR 4.86) and pancreatic surgery (adjusted OR 4.38) as higher risk procedures than aortic surgery (adjusted OR 2.5) (Figure 1).

Figure 1

Absolute incidence of postoperative mortality in relation to type of procedure.


This study revealed a procedure-specific risk classification to accurately identify high-risk patients.


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Correspondence to PG Noordzij.

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Noordzij, P. Postoperative mortality in the Netherlands: identifying high-risk surgery. Crit Care 14, P424 (2010).

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  • Logistic Regression Analysis
  • Emergency Medicine
  • Adverse Outcome
  • Risk Classification
  • Postoperative Mortality