Journal of anesthesia · 2025
Postoperative organ dysfunction assessed using simplified eSOFA is associated with mortality: a single-center retrospective cohort study.
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Hamada Miho, Mizota Toshiyuki, Hirotsu Akiko, Takeda Chikashi, Egi Moritoki
Аннотация
PURPOSE: This study aimed to determine the association between postoperative organ dysfunction evaluated using eSOFA, a simplified measure of organ dysfunction, and postoperative mortality following noncardiac surgery.
METHODS: This study retrospectively analyzed adult patients who underwent noncardiac surgery under general anesthesia between 2009 and 2019. The primary exposure was postoperative organ dysfunction evaluated using eSOFA within 2 postoperative days (positive eSOFA), and the primary outcome was 90-day mortality. Multivariable Cox regression analysis was employed to investigate the association between positive eSOFA and 90-day mortality. In a subanalysis of patients in the surgical intensive care unit (ICU), the predictive performance of the number of eSOFA-positive items for 90-day mortality was compared with those of the Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology And Chronic Health Evaluation (APACHE) II score using Harrell's C-statistic.
RESULTS: This study included 24,558 patients, of whom 7.5% had positive eSOFA, and the postoperative 90-day mortality was 0.9%. Positive eSOFA was independently associated with the occurrence of 90-day mortality (adjusted hazard ratio [HR]: 3.03, 95% confidence interval: 2.16-4.25, P < 0.001). As the number of positive eSOFA items increased, the adjusted HR for 90-day mortality increased. The C-statistics for predicting 90-day mortality in surgical ICU patients using the number of eSOFA-positive items, SOFA score, and APACHE II score were 0.72 (0.65-0.79), 0.73 (0.65-0.80), and 0.74 (0.68-0.81), respectively.
CONCLUSION: Postoperative organ dysfunction evaluated using the eSOFA within 2 postoperative days was independently associated with 90-day mortality in patients who underwent noncardiac surgery.
METHODS: This study retrospectively analyzed adult patients who underwent noncardiac surgery under general anesthesia between 2009 and 2019. The primary exposure was postoperative organ dysfunction evaluated using eSOFA within 2 postoperative days (positive eSOFA), and the primary outcome was 90-day mortality. Multivariable Cox regression analysis was employed to investigate the association between positive eSOFA and 90-day mortality. In a subanalysis of patients in the surgical intensive care unit (ICU), the predictive performance of the number of eSOFA-positive items for 90-day mortality was compared with those of the Sequential Organ Failure Assessment (SOFA) score and the Acute Physiology And Chronic Health Evaluation (APACHE) II score using Harrell's C-statistic.
RESULTS: This study included 24,558 patients, of whom 7.5% had positive eSOFA, and the postoperative 90-day mortality was 0.9%. Positive eSOFA was independently associated with the occurrence of 90-day mortality (adjusted hazard ratio [HR]: 3.03, 95% confidence interval: 2.16-4.25, P < 0.001). As the number of positive eSOFA items increased, the adjusted HR for 90-day mortality increased. The C-statistics for predicting 90-day mortality in surgical ICU patients using the number of eSOFA-positive items, SOFA score, and APACHE II score were 0.72 (0.65-0.79), 0.73 (0.65-0.80), and 0.74 (0.68-0.81), respectively.
CONCLUSION: Postoperative organ dysfunction evaluated using the eSOFA within 2 postoperative days was independently associated with 90-day mortality in patients who underwent noncardiac surgery.