Predictors of mortality and morbidity for acute care surgery patients Monisha Sudarshan, MD, MPH, Liane S. Feldman, MD, Etienne St. Louis, MD, Mostafa Al-Habboubi, MD, Muhamad M. Elhusseini Hassan, MD, Paola Fata, MD, MSc, Dan Leon Deckelbaum, MD, MPH, Tarek S. Razek, MD, MSc, and Kosar A. Khwaja, MD, MBA* Division of General Surgery, Montreal General Hospital, Montreal, Que ´bec, Canada article info Article history: Received 31 March 2014 Received in revised form 19 August 2014 Accepted 4 September 2014 Available online 10 September 2014 Keywords: Acute care surgery Morbidity Mortality Predictive Complications Prognostication Emergency surgery Sepsis Shock abstract Background: As the implementation of exclusive acute care surgery (ACS) services thrives, prognostication for mortality and morbidity will be important to complement clinical management of these diverse and complex patients. Our objective is to investigate prog- nostic risk factors from patient level characteristics and clinical presentation to predict outcomes including mortality, postoperative complications, intensive care unit (ICU) admission and prolonged duration of hospital stay. Methods: Retrospective review of all emergency general surgery admissions over a 1-year period at a large teaching hospital was conducted. Factors collected included history of present illness, physical exam and laboratory parameters at presentation. Univariate anal- ysis was performed to examine the relationship between each variable and our outcomes with chi-square for categorical variables and the Wilcoxon rank-sum statistic for continuous variables. Multivariate analysis was performed using backward stepwise logistic regression to evaluate for independent predictors. Results: A total of 527 ACS admissions were identified with 8.1% requiring ICU stay and an overall crude mortality rate of 3.04%. Operative management was required in 258 patients with 22% having postoperative complications. Use of anti-coagulants, systolic blood pres- sure <90, hypothermia and leukopenia were independent predictors of in-hospital mortal- ity. Leukopenia, smoking and tachycardia at presentation were also prognostic for the development of postoperative complications. For ICU admission, use of anti-coagulants, leukopenia, leukocytosis and tachypnea at presentation were all independent predictive factors. A prolonged length of stay was associated with increasing age, higher American Society of Anesthesiologists class, tachycardia and presence of complications on multivar- iate analysis. Conclusions: Factors present at initial presentation can be used to predict morbidity and mortality in ACS patients. ª 2015 Elsevier Inc. All rights reserved. * Corresponding author. Montreal General Hospital, 1650 Cedar Ave, L9 411, Montreal, Que ´ bec, Canada H3G 1A4. Tel.: þ1 514 934 1934 x44334; fax: þ1 514 934 8210. E-mail address: Kosar.khwaja@mcgill.ca (K.A. Khwaja). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research 193 (2015) 868 e873 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.09.007