Cardiac Arrest Among Surgical Patients An Analysis of Incidence, Patient Characteristics, and Outcomes in ACS-NSQIP

Objectives: To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR). Design: Retrospective cohort study. Setting: American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2010. Main Outcome Measures: Incidence of CPR, complications, mortality, and survival to hospital discharge at 30 days or less after surgery. Results: A total of 6382 nontrauma patients (mean age, 68 years) underwent CPR; 85.9% of events occurred postoperatively, of which 49.8% occurred within 5 days after surgery. Overall incidence of CPR was 1 in 203 surgical cases but varied by specialty (1 in 33 for cardiac surgery vs 1 in 258 for general surgery). The mortality rates varied by specialty (45.0%-74.5%) and were associated with comorbidity burden (58.7% for no comorbidity, 63.1% for 1 comorbidity, and 72.8% for >= 2 co-morbidities; P<.001). A total of 77.6% of CPR patients experienced a complication; approximately 75.0% occurred before or on the day of CPR, and septicemia (26.7%), ventilator dependence (22.1%), significant bleeding (13.9%), and renal impairment (11.9%) were the most common. The overall 30-day mortality was 71.6%. Survival to discharge in 30 postoperative days or less was 19.2%; 9.2% of CPR patients were alive but hospitalized at postoperative day 30. Older age, a preexisting do-not-resuscitate order, renal impairment, disseminated cancer, preoperative sepsis, and postoperative arrest were among the factors independently associated with worse survival. Conclusions: One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients. JAMA Surg. 2013;148(1):14-21