utility of surgical apgar score in predicting morbidity and ...

1

UTILITY OF SURGICAL APGAR SCORE IN PREDICTING

MORBIDITY AND MORTALITY A PROSPECTIVE STUDY

By

DR HARSHA A H

Dissertation submitted to the

Rajiv Gandhi University of Health Sciences Bangalore Karnataka

In partial fulfillment of the requirements for the degree of

MASTER OF SURGERY

In

GENERAL SURGERY

Under the guidance of

DR M R SREEVATHSA

DEPARTMENT OF SURGERY

MSRAMAIAH MEDICAL COLLEGE

BANGALORE

YEAR-2012

Rajiv Gandhi University of Health Sciences

2

DECLARATION BY THE CANDIDATE

I hereby declare that the entire work in this dissertation ldquoUTILITY OF SURGICAL

APGAR SCORE IN PREDICTING MORBIDITY AND MORTALITY A

PROSPECTIVE STUDYrdquo is a bonafide and genuine work carried out by me under the direct

guidance of Dr M R SREEVATHSA Professor Department of General Surgery at M S Ramaiah

Medical College Bangalore

This dissertation or any part thereof has not been submitted by me to any other university for

award of any degree or diploma

Date DR HARSHA A H

Place Bangalore MS RAMAIAH MEDICAL

COLLEGE BANGALORE

3

CERTIFICATE BY THE GUIDE

This is to certify that this dissertation entitled ldquoUTILITY OF SURGICAL APGAR

SCORE IN PREDICTING MORBIDITY AND MORTALITY A PROSPECTIVE

STUDYrdquo Is a bonafide research work done by Dr HARSHA A H under my direct guidance and

supervision in the Department of General Surgery M S Ramaiah Medical College Bangalore in partial

fulfillment of the requirement for the degree of MS (General Surgery) during the academic year 2012

Date Dr M R SREEVATHSA

Place Bangalore Professor and HOD

Department of General Surgery

M S Ramaiah Medical College

Bangalore

4

ENDORSEMENT BY THE HEAD OF THE DEPARTMENT

This is to certify that this dissertation entitled ldquoUTILITY OF SURGICAL APGAR SCORE IN

PREDICTING MORBIDITY AND MORTALITY A PROSPECTIVE STUDYrdquo Is a

bonafide research work done by Dr HARSHA A H under my overall supervision in the Department of

General Surgery M S Ramaiah Medical College Bangalore in partial fulfillment of the requirement for

the degree of MS (General Surgery) during the academic year 2012

Date Dr MRSREEVATHSA




Bangalore

5

ENDORSEMENT BY THE PRINICIPAL


PREDICTING MORBIDITY AND MORTALITY A PROSPECTIVE STUDYrdquoIs a

bonafide work done by Dr HARSHA A H under the direct guidance of Dr M R SREEVATHSA

Professor and HOD Department of General Surgery M S Ramaiah Medical College Bangalore in

partial fulfillment of the requirement for the degree of MS (General Surgery) during the academic year

2012

Date Principal and Dean

Place Bangalore M S Ramaiah Medical College

Bangalore

6

COPYRIGHT


I hereby declare that the Rajiv Gandhi University of Health Sciences Karnataka shall have the

rights to preserve use and disseminate this dissertation thesis in print or electronic format for

academic research purpose

Date

Place Bangalore Dr HARSHA A H

7

ACKNOWLEDGEMENT

I would take this opportunity to express my indebtedness to my teacher and guide

Dr M R SREEVATHSA Professor and HOD of General Surgery for his resolute

guidance precise approach constructive criticism and meticulous supervision throughout the

course of my work and the preparation of the manuscripts that have been a major part of my

learning experience

I would like to thank all the staff members and colleagues in the department of general

surgery who have directly or indirectly helped me during the formulation of my study Lastly I

owe a lot to my parents family members and friends who have been a constant source of

support and inspiration in pursuing my dream of becoming a surgeon

DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT

BACKGROUND AND OBJECTIVES

To evaluate the utility of surgical apgar score in predicting morbidity and 30 day

mortality in general surgical procedures and also to compare the predictability of the score in

elective and emergency surgeries for outcome

METHODS

400 patients undergoing general surgical procedures in M S Ramaiah hospitals from

September 2009 to august 2011were included in the study Necessary data was collected

Surgical Apgar score was calculated for each patient and analysis done

RESULTS AND INTERPRETATION

Age more than 40 years had higher incidence of lower surgical Apgar score and

outcome Major complications were noted in 74 of group 0-2 scores and in only 7 in group

9-10 score 30 day mortality was 50 for 0-2 and 06 for 9-10 scores A relative risk of 30

day mortality of 246 and morbidity of 121 was noted for 0-2 category Of the 297 elective

procedures 22 cases ie only 74 of cases had major complications where as 37 of

emergency surgeries had major complications Major complications were noted in 50 of 0-2

score group in elective cases and 50 in emergency cases whereas only 2 of 9-10 score

group in elective surgeries and 23 in emergency surgeries had major complications In

elective cases a 30 day mortality of 50 in 0-2 25 in 3-4 and 22 in 5-6 groups in

comparison with 9-10 was also statistically significant In emergency group all the apgar scores

had significantly higher 30 day mortality

9

CONCLUSION

SURGICAL APGAR SCORE is a simple and useful method of predicting the morbidity

and the 30 day mortality of patients undergoing general surgical procedures It is more sensitive

in predicting the outcome in emergency cases as compared to the elective cases

KEY WORDS SURGICAL APGAR SCORE MORBIDITY 30 DAY MORTALITY

EMERGENCY SURGERIES

10

CONTENTS

SL NO CONTENTS PAGE NO

1 INTRODUCTION 14

2 OBJECTIVES 20

3 REVIEW OF LITERATURE 22

4 MATERIALS AND METHODS 35

5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11

LIST OF TABLES FIGURES PIE CHARTS AND BAR DIAGRAMS

SL

NO

TABLES PAGE NO

1 POSSUM PARAMETERS 30

2

DESCRIPTION OF THE COMPONENT

PARAMETERS OF THE SURGICAL APGAR SCORE

33

3

CLAVEIN CLASSIFICATION OF GRADING THE

POST OP EVENTS BASED ON THE SEVERITY OF

COMPLICATIONS

41

4 SEX WISE DISTRIBUTION OF 400 PATIENTS 44

5

AGE GROUP WISE DISTRIBUTION OF 400

PATIENTS

44

6

PREOPERATIVE COMORBIDITIES AND THE

COMPLICATION RATES

47

7

DISTRIBUTION OF CASES INTO ELECTIVE AND

EMERGENCY SURGERIES 48

8

TYPES OF SURGERY AND THE COMPLICATION

AND 30 DAY MORTALITY

50

9

SURGICAL APGAR SCORE WITH MAJOR

COMPLICATIONS AND 30 DAY MORTALITY 52

12

10

PERCENTAGE OF POST OP COMPLICATIONS IN

ELECTIVE AND EMERGENCY SURGERIES

53

11

30 DAYS SURGICAL OUTCOMES FOR ELECTIVE

SURGERY IN RELATION TO THE SURGICAL

APGAR SCORE

54

12

30 DAYS SURGICAL OUTCOMES FOR

EMERGENCY SURGERY IN RELATION TO THE

SURGICAL APGAR SCORE

55

SL

NO

FIGURES PAGE NO

1

VARIOUS CHARACTERISTICS ON THE

POSTOPERATIVE COMPLICATIONS AND DEATH

25

2 NEW SIMPLIFIED ACUTE PHYSIOLOGY SCORE 29

13

SL

NO

BAR CHARTS AND PIE DIAGRAMS PAGE NO

1 SEX DISTRIBUTION 44

2 AGE DISTRIBUTION 44

3

PERCENTAGE DISTRIBUTION OF SURGICAL

APGAR SCORE VS AGE YEAR GROUP

45

4


EMERGENCY SURGERIES

48

5


COMPLICATIONS AND 30 DAY MORTALITY

51

14

INTRODUCTION

15

INTRODUCTION

Hospitals and surgical teams strive to provide a consistently low incidence of major

complications for patients undergoing any given operation The prediction of complications is

an essential part of risk management in surgical practice Recognizing patients at high risk of

developing a complication will contribute substantially to the quality of operation and of cost

reduction in surgery Marked variability of postoperative outcomes is usually found due to

differences in patientrsquos preoperative risk factors1

An ideal model to predict complication in surgical patients should be simple and readily

applicable to all patients when operated While developing a predictive model for complications

in surgical patients an accurate estimate of the incidence of these complications is needed

Therefore a proper definition of a complication with a low detection threshold is necessary

However the intraoperative variable response of the body in terms of vital parameters

such as heart rate blood pressure arterial saturation and tissue perfusion to the surgical stress

further contributes to variability in patientsrsquo risk of developing complications1

With the evolution of better monitoring techniques and well equipped laboratories

newer general and specialized surgical scoring systems have emerged as follows-

General SAPS II APACHE II MODS (Multiple Organ Dysfunction Score)

TRIOS (Three days Recalibrated ICU Outcome Score) etc

Specialized Surgical

POSSUM (Physiologic and Operative Severity Score for the enumeration of Mortality

and Morbidity)

16

MPM for cancer patients

Glasgow Coma Score for neurosurgical patients

NSQIP etc

However they are not easily calculated at the bedside Entering numerous data elements

which include patient characteristics and lab data that are not uniformly collected making them

more vulnerable for errors thus losing reproducibility among various multidisciplinary teams

involved in patients care

Prevailing methods of surgical quality assessment such as the American College of

Surgeonsrsquo National Surgical Quality Improvement Program (NSQIP)2ndash4

evaluate surgical

performance indirectly ie by assessing the multiple preoperative risk factors and in addition

attributes disparities between observed and expected complication rates to the treatment

provided

For example in Surgeries for Small Bowel Obstruction Preoperative factors predictive

of postoperative morbidity includes history of CHF cerebrovascular accident with neurologic

deficit history of chronic obstructive pulmonary disease WBC lt4500mm3 functional health

status preoperative creatinine gt12 mgdL and advancing age (in decades) Intraoperatively

higher wound class and ASA class are also predictive of morbidity Operative factors like

simple small bowel resection in comparison to adhesiolysis alone has more incidences of

morbidity and complications 6

Preoperative factors that clearly impact the mortality rate are history of disseminated cancer

preoperative hematocrit lt38 preoperative sodium gt145 mEqL preoperative creatinine gt12

mgdL dyspnea and advancing age (in decades) The finding that elevated WBC occurs more

17

frequently in cases of adhesiolysis than in cases for bowel resection estimates the unreliable

nature of leukocytosis in differentiating inflammation and infection6

Intraoperative factors that predict mortality include advance ASA class and higher wound class

In the operating room surgeons have relied principally on ldquogut-feelingrdquo instead of their

objective assessment of the operative course for postoperative prognostication5 Such

prognostication models have rated the patients in broader categories and provide considerable

clinical guide towards patients care

Most believe that operative management contributes importantly to overall outcomes

but quantitative measurements of operative care are not available1 Among intraoperative

factors the alterations in patientrsquos condition including hypotension7 hypertension

hypothermia bradycardia89

tachycardia and blood loss10

have been independently linked with

adverse perioperative outcomes Some risk prediction methods have integrated these

intraoperative variables for early prediction of postoperative morbidity and mortality

Nevertheless a clear consensus on this most essential aspect of perioperative management of a

surgical patient has not been reached11

Hence the question of how to directly evaluate

performance and safety in the operating room still remains unanswered in surgeons mind12

To provide surgeons with a simple objective and direct method of rating a ten-point

Surgical Apgar Score was determined by Atul Gawande et al13

To derive the score more than

two dozen parameters collected in the operating room were assessed and it was discovered that

just three intraoperative variables remained independent predictors of major postoperative

complications and death They were - Lowest heart rate lowest mean arterial pressure and

estimated blood loss A score built from these three predictors has proved beyond doubt as a

18

strong predictive model for categorizing the patients at risk of major postoperative

complications and death in general and vascular surgery13

As this scoring system requires data that can be collected immediately upon completion

of an operation for patients in any setting regardless of resource and technological capacity it

is the simplest available scoring system for assessing the risk

Like the obstetrical Apgar score 14

it cannot by itself assess the quality of care as its

three variables are influenced not only by the performance of surgical teams but also by the

patientsrsquo preoperative physiological status and the magnitude of the operations they undergo15

For the score to be a clinically useful predictor of postoperative complications each component

of it or the score as a whole should contribute to predict surgical outcome

Because of its simplicity availability in real time being immediately applicable for

clinical decision making and inexpensively collectable Apgar score is therefore a powerful tool

for early recognition of complications Such an early predictability would thereby improve

safety in surgery Despite concordance between preoperative factors and measurement

intraoperative factors after accounting for preoperative risk the Surgical Apgar Score remains a

significant predictor of postoperative complications Because the feedback is almost immediate

this would help the surgical team in categorizing the patients in need of more and intense

postoperative monitoring and care from those who pass an uncomplicated course

It would act as a mode of communication between the surgeons residents nursing staff

about the immediate postoperative status and thereby assist decision making about for example

planned admission after an OPD proceduredaycare procedure admission to ICU or also the

frequency of post op visits to the surgeon Even in those with low surgical apgar scores but

uncomplicated outcome it would enable an early identification of problems as such patients are

19

subjected to routine clinical surveillance and repeated reviews Reliance on anesthesiologistrsquos

unbiased estimation further upgrades the reliability insulating against surgeonrsquos bias16

In this study we will evaluate the predictive ability of the surgical apgar score in general

and vascular surgery

20

OBJECTIVES OF

THE STUDY

21

OBJECTIVES OF THE STUDY

1 To correlate the Surgical Apgar score with the patientrsquos outcome in the form of

complications (morbidity) including death within 30 days of surgery (30 day mortality)

2 To estimate the outcome versus the Surgical Apgar score for both elective and

emergency surgery

22

REVIEW OF

LITERATURE

23

REVIEW OF LITERATURE

Introduction -

The assessment of the potential risks of peri-operative mortality and morbidity is

increasingly important for the provision of health care There is a growing realization that

healthcare providers (doctors) need to ensure appropriate installation or commission of all the

available resources By doing so it would enable the most deserving patients to get most

appropriate healthcare available in the hospital17

Adequate stratification and scoring of risk should therefore be considered essential to

aid clinical practice Assessment of patients for categorization may occur at various points

throughout the patientrsquos journey through the hospital ie from the OPD to WARD to OT to

ICU It can be grouped into three stages relating to the operation

1 Preoperative assessment - this is when planning and intervention can help quantify the

potential risks of a procedure for the patient by virtue of patientrsquos inbuilt physiological

and acquired pathological comorbidites

2 Peri-operative (physiological) assessment may determine the most suitable setting for

further care of the patient ie admission into ICU HDU ward or day care surgical

setup This is based on the preliminary preoperative risk stratification conducted as the

patient arrives to the hospital

3 Post-operative scores calculated from the patients Intraoperative variables and the

responses to these variations may alter the further management of postoperative

patients19

24

One of the prominent works was done on this by P M Markus J Martell et al who

conducted a prospective study of 1077 consecutive patients undergoing major hepatobiliary or

gastrointestinal surgery18

Both elective (n = 827) and emergency (n = 250) procedures were

included The surgeon based on his gut-feeling of the procedure predicted the development of

postoperative complications immediately after completion of surgery on a scale from 0 to 100

per cent These predictions were then compared with the actual outcome and with predictions

made using the Physiological and Operative Severity Score for the enUmeration of Mortality

and morbidity (POSSUM)

The observed morbidity and mortality rates were 295 and 34 per cent respectively

POSSUM predicted a morbidity rate of 464 per cent and P-POSSUM a mortality rate of 69 per

cent The surgeons gut-feeling was more accurate in the prediction of morbidity at 321 per

cent On the basis of gut-feeling surgeons usually over predict the morbidity rates in elective

surgery but underestimate in emergency settings18

Postoperative morbidity and mortality as shown in figure 1 is associated with 3 major

categories of risk factors 1) Patient co morbidity 2) The surgical procedure itself and 3) Risks

directly related to anesthesia management Patient co morbidity - Earlier studies identified the

extremes of ages as a risk factor for perioperative adverse events Infants (0-1 years) and older

persons (65+ years) experience higher rates of postoperative mortality than persons of 2-64

years18

ASA is a well established surrogate measure of patient co morbidity 19

Higher ASA scores are associated increased risk of both 48h and 30d postoperative

mortality Nearly 35 of ASA grade V patients die within 48hrs and nearly 50 of those

patients die within 30d postoperatively Both 48hrs and 30d postoperative mortality rates are

higher after emergency procedure or after operations resulting in post operative ICU

25

admissions An emergency procedure imparts approximately 8 times increased risk if death

within 48h and 3 times increased risk of death within 30 d postoperatively Postoperative ICU

admission is associated with a 2-3 times increased risk of 48h or 30d postoperative mortality

Any surgery associated with a perioperative adverse event imparts a 12 times increased risk of

death within 48h postoperatively and 4 times increased risk of death within 30d

postoperatively20

FIGURE 1- Various characteristics and the risk factors of the patient availability of

resources at the hospital and surgeons experience determines the outcome of a surgery including

the postoperative complications and death

A variety of risk scoring systems are derived from different population of patients for a

variety of purposes and each has their limitations As surgical patients account for up to 70 of

the workload of general intensive care units (ICUs) risk scoring systems that related to ICU and

critically ill patients have also to be categorized

26

Overview of Risk Scoring Systems and Models-

A number of scoring systems exist which have been applied to patients who are acutely

ill and with comorbidites In patients undergoing surgery these risk scoring systems can be

broadly categorized into three groups which relate to the timing of the assessment in relation to

the surgical procedure Outcome is generally measured in terms of mortality as it is a definitive

endpoint and easy to measure A few scores predict both morbidity and mortality while

Some indicate morbidity alone yet almost none seem to measure quality of life or return to pre-

existing function

A brief discussion on the advantages disadvantages the feasibility and the reproducibility of

some of these scores which are routinely practiced in the wards and ICU is worth mentioning

Pre-operative Scores

American Society of Anesthesiologists Score(ASA)-

In 1940-41 ASA asked a committee of three physicians (Meyer Saklad MD Emery

Rovenstine MD and Ivan Taylor MD) to study examine and devise a system for the

collection and tabulation of statistical data in anesthesia which could be applicable under any

circumstances21

Widely used as a surrogate for operative risk assessment the American Society of

Anesthesiologists (ASA) score was originally devised to grade the patients ldquoin relation to

physical status onlyrsquorsquo22

The ASA score is subjective and based on clinical evaluation only

although objective test results will indirectly affect the clinicianrsquos assessment18

27

ASA American Society of Anesthesiologists Grading

I Healthy patient

II Mild systemic disease no functional limitation

III Moderate systemic disease definite functional limitation

IV Severe systemic disease that is a constant threat to life

V Moribund patient unlikely to survive 24 h withwithout operation

Although not intended for use as a risk scoring system the ASA score has been used for

this purpose in part due to the simplicity of the tool its universal use and allowance for

individual patient parameters Limiting factors in its applicability are of the subjectivity lack of

specificity inherent in its design and wide inter-observer variability This classification system

assumes that age of the patient has no relation to physical fitness which is not true Neonates

and the elderly even in the absence of any systemic disease tolerate otherwise similar

anesthetics poorly in comparison to young adults2324

The ASA score has been used to categorize pre-operative risk and is a good indicator of

post-operative mortality19

It does not however provide a quantitative assessment of morbidity

and mortality risk and is better at risk stratification

Surgical Risk Scale -

Sutton et al25

devised the Surgical Risk Scale (SRS) as a comparative surgical audit tool

When prospectively validated it appeared to be effective at predicting mortality The ASA

score is combined with the Confidential Enquiry into Peri-operative Deaths category and British

United Provident Association operative grade resulting in a score from 3 to 15 each of which

relates to a likely mortality score The use of the ASA makes it a partly subjective scoring

28

system The SRS has been shown to have a similar accuracy to Portsmouth Physiological and

Operative Severity Score for EnUmeration of Mortality and Morbidity (P-POSSUM) especially

in higher risk patients yet was easier to calculate 26

Peri-operative Physiological Scores

Acute Physiological and Chronic Health Evaluation (APACHEII)(FIGURE 2)-

The relatively complex scoring system the Acute Physiological and Chronic Health

Evaluation (APACHE) II (Knaus et al 1985) has been derived from large American ICU

patient databases27

While it does not specifically assess surgical patients Goffi et al28

found

that APACHE II could be used pre-operatively ldquowith cautionrdquo in both elective and emergency

surgical patients outside of the ICU or High Dependency Unit (HDU) setting The second

version of APACHE reduced the number of variables to 12 from the original 34 required A

further derivation APACHE III does not seem to be more accurate than APACHE II in the ICU

population and in some studies has been shown to be poorer when used to look at surgical

patients and patients with gastrointestinal disease 27

Overall while widely used and well-

understood calculating APACHE II is complex and time consuming Furthermore the raw data

is not always easily obtainable particularly outside that of the ICU setting

Simplified Acute Physiology Score-

The Simplified Acute Physiology Score (SAPS) is assigned after 24 h of ICU admission

and is another derivation of APACHE The second version SAPS II which uses the original 13

physiological variables also factors in the type of admission (elective or emergency medical or

surgical) and chronic health points (acquired immune deficiency syndrome metastatic cancer

29

and hematological malignancy)29

With its inherent weaknesses APACHE II is preferred to

SAPS II in most units

Figure 2 ndash New simplified Acute Physiology score

Post-Operative Scores

Mortality Prediction Model-

The Mortality Prediction Model (MPM) is normally scored at admission to ICUHDU

with data from within the first hour (MPM0) although older versions could be scored after 24 or

48 h (MPM24 and MPM48 respectively)30

The burden of data collection is low and relates to

the following emergency admission resuscitation cancer chronic renal failure heart rate

systolic blood pressure infection previous ICU admission within 6 months surgery age and

GCS The data allow for greater completeness and subsequently a higher degree of

consistency31

It does not use the worst criteria during the first 24 h unlike APACHE and

therefore can provide a more defined way of comparing admissions to different ICUs32

30

Limitations of the MPM are that some sub-groups are excluded (eg cardiac surgery

myocardial infarction and ICU readmissions) and while only recently updated APACHE IV

and SAPS III still obtain better discrimination

Physiological and Operative Severity Score for EnUmeration of Mortality and

Morbidity(POSSUM)-

The POSSUM predicts the probability of surgical mortality for a range of surgical sub-

populations and allows comparison of performance33

The 12 physiological factors can be

determined pre-operatively (Table 1)

Table ndash 1 ndash POSSUM PARAMETERS

Electively or peri-operatively its use has not been validated with regard to outcome or

need for ICU or HDU admission either Furthermore POSSUM has variable usage across

different specialities which has led to specialty-specific derivations of POSSUM especially in

esophageal 35

and colorectal surgery36

These have ideally increased predictive power at the

expense of decreasing cross-specialty comparison In POSSUM the lowest predictable expected

31

mortality is 1 This value equates to the rate for all patients undergoing general surgery So

POSSUM will effectively exaggerate mortality rates in minor operations

POSSUM is not readily applied to individual patients as it is based on an exponential

equation and the calculated prediction is based on groups These problems as well as that of

ldquogoodness of fitrdquo have led to a more broad-based derivation known as the P-POSSUM score37

Specialty-specific modifications seem to have improved the prognostic features of P-POSSUM

and it has become widely used and accepted as a risk scoring system

Estimation of Physiologic Ability and Stress-

A Japanese comparative audit tool called Estimation of Physiologic Ability and Stress

(E-PASS) has been developed 38

This uses coefficients to combine pre-operative factors (heart-

disease pulmonary disease diabetes performance status) with operative aspects (ratio of blood

loss to body weight operative time type of operationincision) EPASS also incorporates age

and the ASA score It has been evaluated in elective gastrointestinal surgery The postoperative

morbidity rates linearly increases as the CRS(comprehensive risk score) increase The

postoperative mortality rate is only 013 when the CRS is lt 05 97 when the CRS range

from 05 to lt10 and 269 when the CRS is ge10 These results suggest that E-PASS may be

useful in predicting postsurgical risk estimating medical expense and comparing surgical

quality It seems similar to POSSUM and PPOSSUM in its applicability but is a complex

system to score39

32

Surgical Apgar Score -

It was not earlier than 1953 that a 10 point scoring system for evaluation of the

condition of newborn was formulated by Virginia Apgar A simple effective grading system for

predicting the performance of a newborn for the first 28 days14

The simplicity of the Apgar

score in obstetric practice led to its worldwide uptake as an assessment tool

Intraoperative blood loss heart rate and blood pressure are critical predictors of

postoperative risk is consistent with a variety of previous observations Hemodynamic

stability49

and the amount of blood loss 50

during surgery have long been recognized as

important independent factors in patient outcomes What had not been recognized were the

collective importance of these variables and their potential contribution to an easily-

implemented intraoperative performance metric

Gawande et al set out to describe a surgical model which they published in 2007 13

Under the National Surgical Quality Improvement Program 303 randomly selected patients

undergoing colectomy at Brigham and Womenrsquos Hospital Boston were studied The primary

outcomes measure was incidence of major complication or death within 30 days of operation

They validated the score in two prospective randomly selected cohorts 102 colectomy patients

and 767 patients undergoing general or vascular operations at the same institution A 10-point

score as shown in table 2 based on a patientrsquos estimated amount of blood loss lowest heart rate

and lowest mean arterial pressure during general or vascular operations was associated with

major complications or significant 30 day mortality

Similar to early scoring systems it uses important physiological criteria which can be

assessed objectively Criticisms of this scoring system are that operative blood loss can be

subjective although the authors argue the wide categories allow for reasonably accurate

33

estimation The overall score can be used to discriminate which patients are likely to have a

post-operative mortality or morbidity The study showed that the incidence of major

complications was 586 and 36 with the scores of lt4 and gt8 respectively In multivariable

logistic regression it was found that lowest heart rate log EBL and lowest mean arterial

pressure (MAP) were each independent predictors of outcomes

Table 2 ndash Description of the component parameters of the Surgical Apgar Score and its

calculation at the end of the surgery

Surgical apgar score No of points

Variables 0 1 2 3 4

Estimated blood loss ml gt1000 600-1000 101-600 100

---

Lowest mean arterial pressure

mm Hg

lt40 40-54 55-69 70

---

Lowest heart ratemin gt85a 76-85 66-75 56-65 55

a

a occurrence of pathologic bradyarrthymia including sinus arrest atrioventricular block or

dissociation junctional or ventricular escape rhythms and systole also receives 0 points for

lowest heart rate

b lower the cumulative score higher the chances of major complication rates and 30 day

mortality rates

34

The scoring system was also further validated by Scott E Regenbogen Jesse M

Ehrenfeld et al who systematically sampled 4119 general and vascular surgery patients at

Massachusetts General Hospital40

Of 1441 patients with scores of 9 to 10 72 (50) developed

major complications within 30 days including 2 deaths (01) By comparison among 128

patients with scores of 4 or less 72 developed major complications (563) with 25 deaths The

mean lowest HRs were significantly lower (58 vs 63) and the mean lowest MAPs were

significantly higher (65 vs 61) among patients with no complications compared with those with

major complications Estimated blood loss was significantly lower in operations with no major

complications than in those resulting in major complications (25 vs 200 mL)

This study showed that these 3-variable score achieves C statistics of 073 for major

complications and 081 for deaths This indicates that they are independently capable of

predicting both morbidity and mortality and the accuracy improves when they are included in a

score

The subjective element of the ASA score seems to emphasise that there is role for

clinical judgement in assessing patients To overcome interobserver bias the surgical apgar

score has been created to provide an objective score that is easy to measure and calculate While

it has been validated more studies need to be performed before the Surgical Apgar Score

becomes as widely taken up as APACHEII NSQIP and P-POSSUM

35

MATERIALS AND

METHOD

36

MATERIALS AND METHOD

SOURCE OF DATA

A minimum of 400 randomly selected patients undergoing any general surgical

procedures at MS Ramaiah Hospitals were included in the study In view of nonavailability of

vascular procedures during the study period vascular surgical procedures were not included in

this study

INCLUSION CRITERIA

Patients undergoing emergency or elective general surgical procedures under general

epidural or spinal anesthesia

Post operative patients requiring intensive perioperative monitoring in the age group of

15 to 75 years

EXCLUSION CRITERIA

Surgeries under local anesthesia not requiring intensive monitoring and regular follow-

ups

Various determinants such as age sex comorbid conditions presenting disease(s)

procedure executed the surgical apgar score the post op morbidity including complications till

30 days and the 30 day mortality are tabulated and analyzed

Both elective and emergency surgical procedures were allocated into categories for

simplicity as follows (Arvidsson et al) 41

37

MINOR AND INTERMEDIATE

1 Simple alimentary - a) Diagnostic laparoscopy b) Lap cholecystectomy c) Lap

appendectomy d) Resection and anastomosis of small bowel e) Closure of

perforation and f) Perianal procedures like i) Open or stapler haemorrhoidectomy ii)

Repair of prolapsed rectum iii) Drainage of ischiorectal and perianal abscesses

2 Breast surgeries - a) Simple mastectomy and b) Modified radical mastectomy with

axillary dissection with or without reconstruction

3 Total Thyroidectomy with or without centrallateral neck dissection

parathyroidectomy and simple or total parotidectomy with or without neck dissection

3 Groin or umbilical hernia repair ndash a) Anatomical repair like i) Bassinirsquos repair ii)

Shouldicersquos repair and iii) Mayorsquos repair b) Mesh hernioplasty like Lichtensteinrsquos

hernioplasty and

c) Laparoscopic hernia repair like i) Total extraperitoneal repair(TEP)

ii)Transabdominal Preperitoneal repair(TAPP) and iii)Lap paraumbilical hernia repair

4 Skin or soft tissue surgeries ndash extensive skin grafts for severe and large area burns

flaps like PectoralisMajorMyoCutaneous flap Deltopectoral flap and Sural artery flap

MAJOR AND EXTENSIVE

1 Complex alimentary or retroperitoneal like a) Hemicolectomy and Total colectomy

b) Partial and Total Gastrectomy c) Superior mesenteric artery thrombosis with

extensive small bowel resection d) Abdomino perineal resection(APR) e) Anterior

resection of rectum f) Esophagectomy and g) Excision of retroperitoneal tumors

38

2 Hepatobiliary and Pancreas surgery like a) lobectomy and segmentectomy b) Repair

of liver lacerations c) Open cholecystectomy d) Open CBD exploration e)

whipplersquos procedure f) Pancreatic necrosectomy and g) Open or lap splenectomy

3 Large Ventral or incision hernia repair like a) open technique with intraabdominal

biograft mesh b) Underlay or overlay mesh hernioplasty with or without

abdominoplasty

Using parameters like i) ESTIMATED BLOOD LOSS ii) LOWEST HEART RATE

AND iii) LOWEST MEAN ARTERIAL PRESSURE during the surgical procedure the

surgical Apgar score is calculated as shown in the table 2 The cumulative scores are separated

into 5 categories as follows - 0-2 3-4 5-6 7-8 9-10

Table 2 ndash Surgical Apgar Score


Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate

b lower the cumulative score higher the major complication rates and 30 day mortality rate

39

Data such as lowest heart rate and Lowest mean arterial pressures reached during the

procedure are collected from the anesthesiologistrsquos records (electronicmanual)

Estimated blood loss is calculated using the formulae 42

Blood Loss = [(EBV times (Hi - Hf)) ((Hcti + Hctf)2)] + (500 times Tu)

Where 1 Estimated blood volume (EBV) is assumed to be 70 cm3kg

2 Hi and Hf represent pre and post operative haemoglobin

3 Hcti and Hctf represents pre and post operative hematocrit and

4 Tu is the sum of autologous whole blood (AWB) packed red blood cells (PRBC)

and cell saver (CS) units (FFP CRYOPRECIPITATE and APHERESIS) transfused

With an estimate of the probability of the morbidity and mortality status derived from

the apgar score patients are followed up for occurrence of any major complications or death till

30 days postoperatively (30 day mortality) Regular follow ups of all the patients in the study

are performed in the OPD and especially the group with low apgar scores Some of the patients

are followed up by telephonic interview

Relevant clinical investigations either invasive or noninvasive are performed where

physiological parameters indicate development of any organ complications The following

events are considered major complications

1 Acute renal failure

40

2 Bleeding that requires a transfusion of 4U or more of red blood cells within 72 hrs

after surgery

3 Cardiac arrest requiring cardiopulmonary resuscitation

4 Coma of 24 hrs or longer

5 Deep vein thrombosis

6 Myocardial infarction

7 Unplanned intubation

8 Ventilator use for 48hrs or more

9 Pneumonia

10 Pulmonary embolism

11 Stroke

12 Wound disruption

13 Deep or organ-space surgical site infection

14 Sepsis

15 Septic shock and

16 Systemic inflammatory response syndrome

17 Post op Complications of Clavien class III and greater ie those that require

resurgical endoscopic or radiological reintervention for diagnosis of complications

and those requiring intensive care admission43

( table 3 )

Superficial surgical site infection and urinary tract infection are not considered major

complications

The tabulated data were analyzed

41

Table 3 - Clavein classification of grading the post op events based on the severity of

complications

STATISTICAL ANALYSIS

All analyses were performed using the SPSS statistical software version 163 We

analyzed categorical predictors using x2 tests

We performed univariate logistic regression to examine the relationship between major

complication or death and the Surgical Apgar and calculated C statistics with significant p

value of lt005 The results were averaged (mean + standard deviation) for each parameter for

42

continuous data and numbers and percentage for categorical data Proportions were compared

using Chi-square test of significance We used x2 tests and the Cochran- Armitage trend test to

evaluate the relationship between the score and the incidence of both outcomes in elective and

emergency surgical groups

43

RESULTS

44

1 - SEX WISE DISTRIBUTION OF CASES-

Males accounted for 54 of the patients in the present study

2 - AGE GROUP WISE DISTRIBUTION OF CASES -

More than 75 of the patients accounting to 292 cases were in the age group of gt 40 years

PIE CHART 1 - SEX DISTRIBUTION

MALE54(216)

FEMALE46(184)

PIE CHART 2 - AGE DISTRIBUTION

lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14

Table 4 ndash Sex wise distribution of 400 patients

Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400

Table 5 ndash Age group wise distribution of

400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45

3 - PERCENTAGE DISTRIBUTION OF SURGICAL APGAR SCORE VS AGE YEAR

GROUP

178 of patients (10 patients of 56) in the age group of gt60 years had low apgar score of lt 4

Only 27 (3 patients of 108) in the younger age group of lt 40 years have low apgar score of

lt4

905 (144 of 159 patients) with higher apgar score of 9-10 belong to the age group of lt 60

years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100

lt40 yrs(n=108) 40-50 yrs(n=96) 50-60 yrs(n=140) gt60 yrs(n=56)

apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10

APGAR SCORE SUBGROUP IN AGE WISE DISTRIBUTION

P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N

BAR CHART 3 - PERCENTAGE DISTRIBUTION OF SURGICAL APGAR SCORE VS AGE

YEAR GROUP

46

4 - PREOPERATIVE COMORBIDITIES VERSUS COMPLICATION RATES

INCLUDING 30 DAY MORTALITY

The most common co morbidities noted were hypertension(84) smoking (63)

obesity(36) diabetes mellitus (60) cardiac disease (40) pulmonary disease like COPD

and Bronchial asthma and reactive airway disease(35) renal failure(19) including acute

renal failure in 114 and intake of steroids (6) and sepsis (16)

Hypertension diabetes mellitus pulmonary disease cardiac disease chronic renal

failure smoking and sepsis were significantly associated (plt 0001) with postoperative

complications and 30 day mortality Presence of cancer steroid therapy CVA and obesity had

no statistical significance correlation (plt01) between disease and complications

47

Table 6 - PREOPERATIVE COMORBIDITIES AND THE COMPLICATION RATES

PATIENTS PREOP

COMORBIDITIES

Total no of patients =

400

POST OPERATIVE COMPLICATIONS

NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value

Obesity(BMIgt25) 80(20) 64(16) lt02

Hypertension 96(24) 240(60) lt0001

Pulmonary disease 20(5) 120(30) lt0001

Cardiovascular

disease

40(10) 120(30) lt0001

Diabetes mellitus 88(22) 152(38) lt0001

Renal failure 24(6) 52(13) lt0001

Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01

Steroid therapy 8(2) 16(4) lt01

Group total 488 1032

Grand total = 1512

plt005 ndash Statistically significant

48

5 - TOTAL NO OF ELECTIVE AND EMERGENCY SURGERIES

7425 of surgeries were elective in nature 2575 of surgeries were emergencies amounting

to 14th

of total cases

TABLE 7ndash DISTRIBUTION OF CASES INTO ELECTIVE AND EMERGENCY

SURGERIES

TYPE OF SURGERIES NO OF PATIENTS PERCENTAGE

ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000

ELECTIVE(n=297) EMERGENCY(n=103)

7425

2575

BAR DIAGRAM 4 - DISTRIBUTION OF CASES INTO ELECTIVE AND EMERGENCY

SURGERIES

49

6 - CLASSIFICATION OF SURGERIES WITH COMPLICATION RATES AND 30

DAY MORTALITY

55 of cases were minor and intermediate surgeries and 45 of cases were major and extensive

surgeries Major complications noted at 30 days of post operative period constituted 60 cases

ie 313 and 30 day mortality was 51 Major and extensive surgeries has a complication

rate of 271 and 30 day mortality rate of 4 which is statistically significant(plt0001) Minor

procedures has a complication rate of 42 with 11 30 day mortality rate which is also

significant(plt0001)

50

TABLE 8 - Types of surgery and the complication and 30 day mortality

Type of surgery No of cases

Major complications

(Electiveemergency)

30 day mortality

(Elective emergency)

Minor and intermediate 212(55) 9 (42) 2 (11) (plt0001)

Simple alimentary(laparoscopy

and perianal procedures)

114 5 (43)

(14)

2 (17)

(11)

Breast surgery 34 2 (58)

(20)

0

(00)

Thyroid parathyroid and parotid

surgery

16 1 (62)

(10)

0

(00)

Inguinal and paraumbilical

hernia

26 0

(00)

0

(00)

Skin and soft tissue surgery 22 1 (45)

(01)

0

(00)

Major and extensive 188(45) 51 (271) 10 (4) (plt0001)

Complex alimentary and

retroperitoneal

105 25 (238)

(520)

4 (38)

(13)

Ventral herniaincisional hernia 55 13 (236)

(49)

1 (18)

(01)

Hepatobiliary surgery 17 7 (411)

(43)

2 (117)

(11)

Pancreatic surgery 11 6 (544)

(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51

7 - SURGICAL APGAR SCORE WITH MAJOR COMPLICATIONS AND 30 DAY

MORTALITY

783 of cases belonged to high apgar score of 7-10 (ie less complication rates ) and

52 of cases had a low apgar score of lt4 There was a progressive increase in the number of

major complications from 7 in score 9-10 category to 74 in score 0-2 category With the 9-

10 category taken as a reference for assessing the relative risk there was a 121(0-2) 103(3-4)

64(5-6) and 3(7-8) times the risk of developing complications compared to the reference

category 30 day mortality was 06 for 9-10 and 50 for 0-2 category A relative risk of

246(0-2) 122(3-4) 211(5-6) and 148(7-8) for the occurrence of 30 day mortality was seen

with 9-10 as the reference category

50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths

SURGICAL APGAR SCORE IN CATEGORIES

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

BAR DIAGRAM 5 - SURGICAL APGAR SCORE WITH MAJOR COMPLICATIONS


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52

TABLE 9 - SURGICAL APGAR SCORE WITH MAJOR COMPLICATIONS AND 30 DAY

MORTALITY

Surgical Apgar score categories

0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)

Major complications 4(74) 8(55) 19(30) 18(12) 11(7)

Relative risk for major

complications

(95confidence interval)

121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)

Relative risk for 30 day

mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53

8 - PERCENTAGE OF POST OP COMPLICATIONS IN ELECTIVE AND

EMERGENCY SURGERIES

Of the 297 elective procedures 22 cases ie only 74 of cases had 30 day major

complications excluding mortality where as 37 of emergency admissions and surgeries had a

30 day major complications excluding mortality

TABLE 10 ndash PERCENTAGE OF POST OP COMPLICATIONS IN ELECTIVE

AND EMERGENCY SURGERIES

POST OP MAJOR COMPLICATIONS ELECTIVE

CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103

ACUTE RENAL FAILURE 4 8

TRANSFUSION OF gt4UNITS 0 4

CARDIAC ARREST WITH CPR 1 2

DEEP VEIN THRMBOSIS 1 1

MYOCARDIAL INFARCTION 2 2

PROLONGED VENTILATION(gt48HRS) 0 2

PNEUMONIA 3 7

PULMONARY EMBOLISM 2 0

STROKE 1 0

WOUND DISRUPTION 4 5

DEEP ORGAN SPACE INFECTION 3 4

SEPSIS AND SHOCK 1 3

Grand total 22 74 38 37

54

9 - 30 DAY MORTALITY AND MAJOR COMPLICATION IN ELECTIVE AND

EMERGENCY SURGERIES VS SURGICAL APGAR SCORE

Major complications were noted in 50 of 0-2 score group 50 of 3-4 group and 31

of 5-6 score group and were statistically significant(plt00001) 30 day mortality of 50 in 0-2

25 in 3-4 and 22 in 5-6 were also statistically significant No significant association was

seen between higher score of gt7 and the occurrence of major complications

Table 11 - 30 days surgical outcomes for elective surgery in relation to the surgical

apgar score

ELECTIVE SURGERY ndash NO OF CASES 297

Surgical

apgar score

No of cases No of major

complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223

plt0001 ndash statistically significant

55

`Major complications were noted in 75 of 0-2 score group with 25 30 day mortality

66 of 3-4 group with 18 mortality 71 of 5-6 score group with 14 mortality 45 of 7-8

group with 7 mortality and 23 of 9-10 score group with 3 30 day mortality and were

statistically significant(plt00001)

Table 12 - 30 days surgical outcomes for emergency surgery in relation to the surgical

apgar score

EMERGENCY SURGERY ndash NO OF CASES - 103

Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION

A simple surgical score based on estimated blood loss lowest HR and lowest MAP

during an operation provides a meaningful estimate of patientrsquos condition and rate of major

complications and death after surgery

All 400 cases admitted in the department of general surgery were evaluated as described

earlier in the methods and methodology All the patients were appropriately assessed and

managed according to standard guidelines for the respective disease

54 of the surgical cases in our study were male patients (table 4) Most of the studies

on the apgar score by Gawande et al and Scott et al show a female preponderance of cases of

56 to 65 in different cohort of study40

However there has been no association between

gender the score and the prognosis in these studies

More than 75 of the patients were in the age group of more than 40years (table 5)

Only 27 of patients belonged to agelt 40 years Similar age distribution with an average of

553 years to 636 years has been noted in previous studies 40

Majority of the complications were noted in the age group gt 50 years 178 of patients

(10 patients of 56) in the age group of gt60 years had low apgar score of lt 4 Only 27 (3

patients of 108) in the younger age group of lt 40 years have low apgar score of lt4 905 (144

of 159 patients) with higher apgar score of 9-10 belong to the age group of lt 60 years (bar chart

3) A study by Gawande et al showed significantly high rates of major complications of 16

with a mean age of 642 years 13



58

and Bronchial asthma and reactive airway disease(35) intake of steroids predominantly as

inhalers and tablets for pulmonary and collagen vascular disease(28) renal failure(19)

including acute renal failure in 114 and sepsis secondary to hollow viscus perforation

necrotizing enterocolitis pyocoele of gallbladder and peritonitis(16) (Table 6) Hypertension

diabetes mellitus pulmonary disease cardiac disease chronic renal failure smoking and sepsis

were significantly associated with postoperative complications and death in this study(plt0001)

Other studies show similar comorbid conditions associated with poor prognosis 43

Some of the

additional risk factors noted are ASA classgt 3 under weight (BMIlt185) open wound weight

loss gt 10 in 6 months ascites and gangrene 40

No significant difference in the occurrence of the complications or 30 day mortality

noted with cancer steroid therapy CVA and obesity as compared with Scott et al 40

Another

study by Atul gawande et al where a cohort of 303 colectomy cases were analyzed do not show

any significant correlation with BMI cardiovascular disease pulmonary disease preoperative

sepsis malignancy or blood transfusion 13

7425 of surgeries in this study were elective in nature 2575 of surgeries were

emergencies amounting to only 14th

of total cases (table 7) A study on the emergency surgical

admissions by Capewell et al showed that 46 to 57 of all surgical admissions are emergency

in nature44

Majority of the surgeries were minor or intermediate (55) and major or extensive

surgeries were performed in 45 of patients Even after stratifying the patients by the

magnitude of operation the score remained a highly significant predictor of outcome About

42 of minor surgeries had major complications and 11 30 day mortality rate where as

59

271 major complications and 4 30day mortality rates were noted with major and extensive

surgeries (table 8)

A Study by Scott et al showed an incidence of major complications in 48 vs 213 in

minor and major surgeries40

A death rate of 04 vs 37 between minor and major surgeries

was seen in a cohort of general surgery Among major surgeries patients with scores of 4 or

less were 65 times more likely to have a major complication (95CI 47-89 plt0001) and

112 times more likely to die (95 CI 1532-819 plt0001) within 30 days of surgery However

even after minor or intermediate surgery score of 4 or less were 228 times more likely to

experience a major complications and 814 times more likely to die( plt0001) 13

Of the 400 patients there was a 51 30 day mortality 313 major complications (lt

30 days) and 32(8) had minor complications with 306(77) having no complications Mean

surgical apgar score was 785(+-149SD) The difference in surgical outcome between patients

in different score group was also statistically significant Among the 21(52) patients with

surgical apgar score of lt4 major complications occurred in 571 and a 30 day mortality of

238 was seen In contrast among 159(397) patients with surgical apgar score of 9-10

only 69 suffered a major complication and only 06 patient succumbed within 30 days (bar

diagram 5)

With the 9-10 category taken as a reference for assessing the relative risk there was a

121(0-2) 103(3-4) 64(5-6) and 3(7-8) times the risk of developing complications compared

to the reference category Considering 9-10 as the reference category a relative risk of 246(0-2)

122(3-4) 211(5-6) and 148(7-8) for the occurrence of 30 day mortality was seen (table 9)

60

It was also noted that in every 2 point score category the incidence of both major

complications and death was significantly greater than that of patients in the next- higher

category(plt0001) A similar result with a relative risk of major complication amongst low

scored operations was 161(95 CI 77-340plt00001) compared with those in the high

scored operation was noted in the study by Atul A Gawande et al 13

The most common complication noted in the study was 1) acute renal failure (20) 2)

post of pneumonia (166) 3) wound disruption (15) 4)deep or organ space surgical site

infection (116) 5)Myocardial infarction(4) and 5) sepsis(4)(table 10)

Four patients required transfusion of gt4 units of packed cell in a day and 2 of them

succumbed due to Disseminated intravascular coagulation Of the 12 deaths in the study period

9 patients died of cardiopulmonary arrest due to cardiovascular event ARDS and sepsis 2 died

of disseminated intravascular coagulation and a patient succumbed due to cerebrovascular

accident

The relative risk of predicting a major complication was significantly higher in all the

subgroups of the apgar score for emergency surgeries as compared to its elective surgeries

where the statistical power was limited by the lowest scores (table 11 and table 12) Study by

Atul gawande etal showed a statistically significant result with an odds ratio of 48(95 CI

241-957) for emergency procedures 13

Other studies have shown complication rates of 43

and a mortality of 4 in emergency GI procedures45

In this regard even the P-POSSUM has no morbidity prediction equation as a result of

the original authorsrsquo lack of confidence in the reporting of perioperative complications46

Subsequent studies have shown P-POSSUM to both over-predict and under-predict mortality

47

in different settings

61

A study by Knaus WA et al on APACHE III risk prediction model have shown that the

overall predictive accuracy of the first-day APACHE III equation within 24 h of ICU admission

following a major surgery would be given a risk estimate for hospital death that was within 3

percent 48

INFERENCE ndash

The age group selected ranged from 15 to 75 years In this study patients with age group

of more than 40 years constituted majority of the surgical population constituting more than

75

There was no significant difference in the sex wise distribution of surgical cases

This study showed that 178 of the operated patients in the age group more than 60

years had a low surgical apgar score of less than 4 This indicated that the older age groups had

low apgar score and hence the increased incidence of a major complication or 30 day mortality

than younger population with similar low apgar score

It was seen in this study that Comorbidities like Hypertension diabetes mellitus

pulmonary disease cardiac disease chronic renal failure smoking and sepsis were significantly

associated (plt 0001) with postoperative complications and 30 day mortality However cancer

steroid therapy CVA and obesity had no significance correlation with the complications or

mortality

This study witnessed that surgical apgar score of less than 2 had a relative risk of 121

for the occurrence of major complications and a relative risk of 246 for 30 day mortality

62

34th

of cases in this study were operated on elective basis with only 26 of emergency

surgical procedures

There was a higher incidence of major complications in the surgical procedures done on

emergency basis than the elective surgeries However it was evident in this study that the major

complications and 30 day mortality were seen to be higher in emergency surgical groups

compared with the elective surgical groups with respect to all the 5 subcategories of Apgar

score Further study need to be conducted on the emergency subgroups in particular for it to be

validated

63

CONCLUSION

64

CONCLUSION

1) In this study surgical Apgar score has proved to be an important tool in early detection

of the complications

2) Patients more than 40 years have Low surgical apgar scores after any general surgical

procedure and hence are at risk for major complications including high mortality

3) Comorbidities like Smoking hypertension diabetes mellitus cardiovascular

pulmonary renal failure and sepsis were found to be significant preoperative factors

associated with higher chances of complications

4) Patients with Low surgical Apgar score would require ICU monitoring or would require

admission in the hospital even if undergoing a day care procedure

5) Complications rates are five times higher in emergency surgeries in comparison to

elective cases

6) 10 point Apgar scoring system is superior in identifying the patients at risk of

complications and 30 day mortality in Emergency surgeries

65

SUMMARY

66

SUMMARY

The aim of this study was to evaluate the efficacy of surgical apgar score in predicting

the morbidity and 30 day mortality in various general surgical procedures It was also studied

for the effectiveness of the score in predicting the morbidity and 30 day mortality in elective

and emergency surgeries

400 surgical cases admitted in the department of general surgery at MSRamaiah

hospitals underwent surgical procedures which were categorized into minor and major surgeries

based on classification of arvindsonn et al At the end of each procedure surgical apgar score

was calculated using the parameters like lowest heart rate lowest mean arterial pressure and

estimated blood loss

Patients with more than 40 years had low surgical apgar scores at the end of surgical

procedure This group of patients was at higher risk of having a major complication or death

during the follow up period

Patients with certain comorbid factors like Smoking hypertension diabetes mellitus

cardiovascular pulmonary renal failure and sepsis were at risk of having a major complication

or death during the follow up period All Patients with Low surgical Apgar score would require

ICU monitoring or would require admission in the hospital even if the patient underwent a day

care procedure

Patients who underwent emergency surgeries irrespective of the surgical apgar scores

had 5 times higher complications and 30 day mortality in comparison with the patients who

underwent an elective surgery

67

In emergency surgeries patients with all subgroup of scores had higher rates of

complications and 30 day mortality In elective surgeries lower scores of less than 7 had higher

rates of complications and 30 day mortality in comparison to scores of more than 7

This study there by concluded that the surgical apgar score which is a 10-point score

based on the lowest HR lowest MAP and EBL discriminated well between groups of patients

at high risk and lower-than-average risk of major complications and death within 30 days of the

surgery The score also served as a simple aid in communication among surgeons post

anesthesia care providers surgical residents and ICU OR surgical ward staff regarding patientsrsquo

immediate postoperative status It also helped to convey to the attenders about the condition and

prognosis after surgery

Thus surgical Apgar score holds promise as both a prognostic measure and a clinical

decision support tool

68

BIBILOGRAPHY

69

BIBILOGRAPHY

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from concept to measurement Ann Surg 2004239(4)475ndash82

2 Fink AS Campbell DA Jr Mentzer RM Jr et al The National Surgical Quality

Improvement Program in non-veterans administration hospitals initial demonstration of

feasibility Ann Surg 2002236(3)344ndash53 discussion 353ndash4

3 Khuri SF Daley J Henderson W et al The National Veterans Administration Surgical Risk

Study risk adjustment for the comparative assessment of the quality of surgical care J Am Coll

Surg 1995180(5)519ndash31

4 Khuri SF Daley J Henderson W et al Risk adjustment of the postoperative mortality rate

for the comparative assessment of the quality of surgical care results of the National Veterans

Affairs Surgical Risk Study J Am Coll Surg 1997185(4)315ndash27

5 Hartley MN Sagar PM The surgeonrsquos lsquogut feelingrsquo as a predictor of post-operative outcome

Ann R Coll Surg Engl 199476(6 Suppl)277ndash8

6 Julie A Margenthaler MD Walter E Longo MD et al Risk Factors for Adverse Outcomes

Following Surgery for Small Bowel Obstruction Ann Surg 2006 April 243(4) 456ndash464

7 Mauney FM Jr Ebert PA Sabiston DC Jr Postoperative myocardial infarction a study of

predisposing factors diagnosis and mortality in a high risk group of surgical patients Ann Surg

1970172(3)497ndash503

8 Reich DL Bodian CA Krol M et al Intraoperative hemodynamic predictors of mortality

stroke and myocardial infarction after coronary artery bypass surgery Anesth Analg

199989(4)814ndash22

70

9 Rohrig R Junger A Hartmann B et al The incidence and prediction of automatically

detected intraoperative cardiovascular events in noncardiac surgery Anesth Analg

200498(3)569ndash77

10 Gatch WD Little WD Amount of blood lost during some of the more common operations

JAMA 1924831075ndash1076

11 Copeland GP Jones D Walters M POSSUM a scoring system for surgical audit Br J Surg

199178(3)355ndash60

12 Greenberg CC Roth EM Sheridan TB et al Making the operating room of the future safer

Am Surg 200672(11)1102ndash8 discussion 1126ndash48

13 Gawande AA Kwaan MR Regenbogen SE et al An Apgar Score for Surgery J Am Coll

Surg 2007204(2)201ndash208

14 Apgar V A proposal for a new method of evaluation of the newborn infant Curr Res

Anesth Analg 195332(4)260ndash7

15 Charlson ME MacKenzie CR Gold JP et al Preoperative characteristics predicting

intraoperative hypotension and hypertension among hypertensives and diabetics undergoing

noncardiac surgery Ann Surg 1990212(1)66ndash81

16 Delilkan AE Comparison of subjective estimates by surgeons and anaesthetists of operative

blood loss Br Med J 19722(5814)619-621

17 National Institute for Health and Clinical Excellence Acutely ill patients in hospital

recognition of and response to acute illness in adults in hospital London National Institute for

Health and Clinical Excellence 2007

18 Markus PM Martell J Leister I Horstmann O Brinker J Becker H Predicting post-

operative morbidity by clinical assessment Br J Surg 200592(1)101ndash106

71

19 Wolters U Wolf T Stutzer H Schroder T ASA classification and perioperative variables as

predictors of post-operative outcome Br J Anaesth 199677(2)217ndash222

20 Lee A Lum ME ORegan WJ Hillman KM Early post-operative emergencies requiring an

intensive care team intervention The role of ASA physical status and after-hours surgery

Anaesthesia 199853(6)529ndash535

21 Hall JC Hall JL ASA status and age predict adverse events after abdominal surgery J Qual

Clin Pract 199616(2)103ndash108

22 Saklad M Grading of patients for surgical procedures Anesthesiology 19412281ndash284

23 Goldhill DR Preventing surgical deaths critical care and intensive care outreach services in

the post-operative period Br J Anaesth 200595(1)88ndash94

24 Owens WD Felts JA Spitznagel EL Jr ASA physical status classifications a study of

consistency of ratings Anesthesiology197849(4)239ndash243

25 Sutton R Bann S Brooks M Sarin S The Surgical Risk Scale as an improved tool for risk-

adjusted analysis in comparative surgical audit Br J Surg 200289(6)763ndash768

26 Brooks MJ Sutton R Sarin S Comparison of Surgical Risk Score POSSUM and p-

POSSUM in higher-risk surgical patients Br J Surg 200592(10)1288ndash1292

27 Knaus WA Zimmerman JE Wagner DP Draper EA Lawrence DE APACHE-acute

physiology and chronic health evaluation a physiologically based classification system Crit

Care Med 19819(8)591ndash7

28 Goffi L Saba V Ghiselli R Necozione S Mattei A Carle F Preoperative APACHE II and

ASA scores in patients having major general surgical operations prognostic value and potential

clinical applications Eur J Surg 1999165(8)730ndash735

72

29 Le Gall JR Lemeshow S Saulnier F A new Simplified Acute Physiology Score (SAPS II)

based on a EuropeanNorth American multicenter study JAMA 1993270(24)2957ndash2963

30 Teres D Lemeshow S Avrunin JS Pastides H Validation of the mortality prediction model

for ICU patients Crit Care Med 198715(3)208ndash213

31 Shann F Mortality prediction model is preferable to APACHE BMJ 2000320(7236)714-37

32 Kramer AA Assessing contemporary intensive care unit outcome an updated Mortality

Probability Admission Model (MPM0-III) Crit Care Med 200735(3)827ndash835


199178(3)355ndash360

34 Lagarde SM Maris AK de Castro SM Busch OR Obertop H van Lanschot JJ Evaluation

of O-POSSUM in predicting inhospital mortality after resection for oesophageal cancer Br J

Surg 200794(12)1521ndash1526

35 Vather R Zargar-Shoshtari K Adegbola S Hill AG Comparison of the possum P-

POSSUM and Cr-POSSUM scoring systems as predictors of post-operative mortality in patients

undergoing major colorectal surgery ANZ J Surg 200676(9)812ndash816

36 Whiteley MS Prytherch DR Higgins B Weaver PC Prout WG An evaluation of the

POSSUM surgical scoring system Br J Surg 199683(6)812ndash815

37 Prytherch DR Whiteley MS Higgins B Weaver PC Prout WG Powell SJ POSSUM and

Portsmouth POSSUM for predicting mortality Physiological and Operative Severity Score for

the enUmeration of Mortality and morbidity Br J Surg 199885 (9)1217ndash1220

38 Haga Y Ikei S Wada Y Takeuchi H Sameshima H Kimura O et al Evaluation of an

Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict

postoperative risk a multicenter prospective study Surg Today 200131(7)569ndash574

73

39 Haga Y Wada Y Takeuchi H Kimura O Furuya T Sameshima H et al Estimation of

physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery

Surgery 2004135(6)586ndash594

40 Scott E Regenbogen Jesse M Ehrenfeld Stuart R Lipsitz Caprice C Greenberg Matthew M

Hutter Atul A Gawande Utility of the Surgical Apgar Score Validation in 4119 Patients Arch

Surg 2009144(1)30-36

41 Arvidsson S Ouchterlony J Sjostedt L Svardsudd K Predicting postoperative adverse

events clinical efficiency of four general classification systems the project perioperative risk

Acta Anaesthesiol Scand 199640(7)783-791

42 T Casey McCullough Jonathan V Roth Phillip C Ginsberg Richard C Harkaway

Estimated Blood Loss Underestimates Calculated Blood Loss during Radical Retropubic

Prostatectomy Urol Int 20047213-16

43 Dindo D Demartines N Clavien PA Classification of surgical complications a new

proposal with evaluation in a cohort of 6336 patients and results of a survey Ann Surg

2004240(2)205-213

44 Capewell S The continuing rise in emergency admissions Bmj 1996 312(7037)991-992

45 Schwesinger WH Page CP Gaskill HV 3rd Steward RM Chopra S Strodel WE Sirinek

KR Operative management of diverticular emergencies Strategies and outcomes Arch Surg

2000 135558-563

46 Prytherch DR Whiteley MS Higgins B et al POSSUM and Portsmouth POSSUM for

predicting mortality Physiological and Operative Severity Score for the enUmeration of

Mortality and morbidity Br J Surg 1998851217-20

74


POSSUM in higher-risk surgical patients Br J Surg 2005921288-92

48 Wong DT Knaus WA The APACHE III prognostic system Risk prediction of hospital

mortality for critically ill hospitalized adults Can J Anaesth 1991 38 374-83

49 Hartmann B Junger A Rohrig R et al Intra-operative tachycardia and peri-operative

outcome Langenbecks Arch Surg 2003388(4)255ndash60


JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA

NAME ndash AGE ndash SEX -

ADDRESS - TELEPHONE NO ndash

OCCUPATION-

FINAL PREOP DIAGNOSIS-

COMORBIDITIES-

SURGICAL PROCEDURE EXECUTED-

ELECTIVE EMERGENCY

MINOR MAJOR PREOP HEMOGLOBIN AND HEMATOCRIT-

POST OP HEMOGLOBIN AND HEMATOCRIT-

LOWEST HEART RATE-

LOWEST MEAN ARTERIAL PRESSURE-

ESTIMATED BLOOD LOSS-

SURGICAL APGAR SCORE-

POST OP COMPLICATIONS-

lt24 HRS lt1 WEEK UPTO 30 DAYS

MORTALITY-


CAUSE OF DEATH -

2


I hereby declare that the entire work in this dissertation ldquoUTILITY OF SURGICAL

APGAR SCORE IN PREDICTING MORBIDITY AND MORTALITY A

PROSPECTIVE STUDYrdquo is a bonafide and genuine work carried out by me under the direct

guidance of Dr M R SREEVATHSA Professor Department of General Surgery at M S Ramaiah

Medical College Bangalore

This dissertation or any part thereof has not been submitted by me to any other university for

award of any degree or diploma

Date DR HARSHA A H

Place Bangalore MS RAMAIAH MEDICAL

COLLEGE BANGALORE

3











Bangalore

4











Bangalore

5







2012



Bangalore

6

COPYRIGHT





Date


7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

3











Bangalore

4











Bangalore

5







2012



Bangalore

6

COPYRIGHT





Date


7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

4











Bangalore

5







2012



Bangalore

6

COPYRIGHT





Date


7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

5







2012



Bangalore

6

COPYRIGHT





Date


7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

6

COPYRIGHT





Date


7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

7

ACKNOWLEDGEMENT





learning experience





DATE Dr HARSHA A H

BANGALORE

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

8

ABSTRACT





METHODS
















9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

9

CONCLUSION





EMERGENCY SURGERIES

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

10

CONTENTS


1 INTRODUCTION 14

2 OBJECTIVES 20



5 RESULTS 43

6 DISCUSSION 56

7 CONCLUSION 63

8 SUMMARY 65

9 BIBLIOGRAPHY 68

10 ANNEXURE 75

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

11


SL

NO

TABLES PAGE NO


2



33

3



COMPLICATIONS

41


5


PATIENTS

44

6


COMPLICATION RATES

47

7



8



50

9



12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

12

10



53

11



APGAR SCORE

54

12




55

SL

NO

FIGURES PAGE NO

1



25


13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

13

SL

NO




3



45

4


EMERGENCY SURGERIES

48

5



51

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

14

INTRODUCTION

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

15

INTRODUCTION




















and Morbidity)

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

16



NSQIP etc







evaluate surgical



provided











17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

17



























18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

18

























19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

19





20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

20

OBJECTIVES OF

THE STUDY

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

21





emergency surgery

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

22

REVIEW OF

LITERATURE

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

23


Introduction -



















patients19

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

24




















years18






25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

25






postoperatively20








26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

26








existing function








circumstances21






27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

27


I Healthy patient

















Sutton et al25






28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

28








patient databases27


found















29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

29














consistency31



30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

30





Morbidity(POSSUM)-









esophageal 35




31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

31




















system to score39

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

32









stability49


















33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

33









Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


mortality rates

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

34














score






35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

35

MATERIALS AND

METHOD

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

36


SOURCE OF DATA




this study

INCLUSION CRITERIA




15 to 75 years

EXCLUSION CRITERIA


ups






37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

37












hernioplasty and





MAJOR AND EXTENSIVE





38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

38






abdominoplasty







Variables 0 1 2 3 4


---


mm Hg

lt40 40-54 55-69 70

---


a



lowest heart rate


39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

39



















40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

40


after surgery







9 Pneumonia


11 Stroke

12 Wound disruption


14 Sepsis

15 Septic shock and





( table 3 )


complications


41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

41


complications







42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

42





43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

43

RESULTS

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

44






MALE54(216)

FEMALE46(184)


lt40 YEARS - 27

40-50 YEARS - 24

50-60 YEARS - 35

gt60 YEARS - 14


Sex Number of

patients

Percentage

Male 216 54

Female 184 46

Grand Total 400


400 patients

Age group Number of

patients

Percentage

lt 40 years 108 27

40-50 years 96 24

50-60 years 140 35

gt60 years 56 14

Grand total 400

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

45


GROUP



lt4


years

1 1 1 3 2 3 3 7

16 15 16 19

50

38

54

12

39 39

66

15

05

101520253035404550556065707580859095

100


apgar score 0-2

apgar score 3-4

apgar score 5-6

apgar score 7-8

apgar score 9-10


P

E

R

C

E

N

T

A

G

E

D

I

S

T

R

I

B

U

T

I

O

N


YEAR GROUP

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

46











47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

47


PATIENTS PREOP

COMORBIDITIES


400


NO COMPLICATIONS

No of patients and

percentage

COMPLICATIONS WITH

DEATH

No of patients and

percentage

p value




Cardiovascular

disease

40(10) 120(30) lt0001



Sepsis 28(7) 36(9) lt0001

CVATIA 4(1) 12(3) lt01

Smoking 80(20) 172(43) lt0001

Cancer 20(5) 48(12) lt01



Grand total = 1512


48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

48



to 14th

of total cases


SURGERIES


ELECTIVE 297 7425

EMERGENCY 103 2575

GRAND TOTAL 400

000

2000

4000

6000

8000


7425

2575


SURGERIES

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

49


DAY MORTALITY







50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

50



Major complications

(Electiveemergency)

30 day mortality





114 5 (43)

(14)

2 (17)

(11)


(20)

0

(00)


surgery

16 1 (62)

(10)

0

(00)


hernia

26 0

(00)

0

(00)


(01)

0

(00)



retroperitoneal

105 25 (238)

(520)

4 (38)

(13)


(49)

1 (18)

(01)


(43)

2 (117)

(11)


(51)

3 (2272)

(21)

GRAND TOTAL 400 60(313) 12(51)

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

51


MORTALITY









50

20

6 12 06

74

55

30

12 7

0

10

20

30

40

50

60

70

80

90

100

0-2 3-4 5-6 7-8 9-10

Complications

Deaths


PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH



PER

CEN

TAG

E C

OM

PLI

CA

TIO

NS

AN

D D

EATH

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

52


MORTALITY


0-2 3-4 5-6 7-8 9-10

No of patients 6(15) 15(37) 66(165) 154(385) 159(397)



complications


121 103 64 30 1

[reference

category]

30 day mortality 2(50) 3(20) 4(6) 2(12) 1(06)


mortality

(95 confidence

interval)

2464 122 211 148 1

[reference

category]

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

53


EMERGENCY SURGERIES







CASES

No of cases - 297

EMERGENCY

CASES

No of cases - 103







PNEUMONIA 3 7


STROKE 1 0





54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

54








apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of major

complications 30

day mortality

p VALUE

0-2 2 11 5050 lt00001

3-4 4 21 5025 lt00001

5-6 45 61 1322 lt00001

7-8 126 70 59 012

9-10 120 60 2

Grand total 297 223


55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

55






apgar score


Surgical

apgar score


complications 30

day mortality

Percentage of

major

complications

30 day mortality

p VALUE

0-2 4 31 75 25 lt00001

3-4 11 62 66 18 lt00001

5-6 21 133 7114 lt00001

7-8 28 112 45 7 lt00001

9-10 39 51 23 3 lt00001

Grand total 103 389


56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

56

DISCUSSION

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

57

DISCUSSION























58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

58








Some of the





Another








in nature44





59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

59


surgeries (table 8)
















diagram 5)





60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

60













accident











47


61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

61




percent 48

INFERENCE ndash



75










mortality



62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

62

34th


surgical procedures






validated

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

63

CONCLUSION

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

64

CONCLUSION











elective cases



65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

65

SUMMARY

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

66

SUMMARY

















care procedure




67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

67













68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

68

BIBILOGRAPHY

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

69

BIBILOGRAPHY








Surg 1995180(5)519ndash31










1970172(3)497ndash503



199989(4)814ndash22

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

70



200498(3)569ndash77


JAMA 1924831075ndash1076


199178(3)355ndash60




Surg 2007204(2)201ndash208













71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

71























72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

72









199178(3)355ndash360



Surg 200794(12)1521ndash1526












73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

73






Surg 2009144(1)30-36









2004240(2)205-213




2000 135558-563




74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

74








JAMA 1924831075ndash1076

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

75

ANNEXURE

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

76

PROFORMA



OCCUPATION-


COMORBIDITIES-


ELECTIVE EMERGENCY



LOWEST HEART RATE-






MORTALITY-


CAUSE OF DEATH -

utility of surgical apgar score in predicting morbidity and ...

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Transcript of utility of surgical apgar score in predicting morbidity and ...