Inpatient Postoperative Mortality: Comparing Patients Hospitalized Preoperatively to Those Having Elective Surgery.

Summary

In a statewide cohort of 1.25 million adult major surgeries, approximately 95% of in-hospital postoperative deaths occurred after nonelective surgery, which also comprised 70% of cases. Elective surgery had a markedly lower relative risk of death (0.13) and fewer major complications. The study urges shifting public health and quality improvement strategies toward patients already hospitalized preoperatively and trauma-related surgeries.

Key Findings

• Nonelective surgeries accounted for 94.5% of 20,874 in-hospital postoperative deaths and 70% of hospitalizations.
• Elective surgery had a relative risk of death of 0.13 (95% CI 0.12–0.14) versus nonelective.
• Major complications (AKI, hospital-acquired pneumonia, MACE, infection) were all less frequent in elective cases.

Clinical Implications

Benchmark elective surgery mortality separately from nonelective. Prioritize perioperative optimization, monitoring, and postoperative care pathways for already-admitted and trauma surgery patients, where the mortality burden resides.

Limitations

• Retrospective design with potential coding and residual confounding
• Single-state data (Florida, 2021–2022) and in-hospital outcomes only

Future Directions

Develop risk-adjusted, nonelective-specific perioperative mortality metrics and test targeted interventions for inpatient surgical populations including trauma.