Chiu et al evaluated patients who went to surgery despite being classified as extreme risk. These can help to identify a patient for whom surgery may be futile. The authors are from Yale School of Medicine and Texas Tech.

Patient selection: surgical patient


Extreme risk: estimated mortality risk by NSQIP mortality risk calculator >= 75%


Futile surgery: death <= 48 hours after surgery in a patient at extreme risk


Mortality rate: 32% within 2 days; 71% within 30 days


Predictors of futile surgery:

(1) age >= 65 years (odds ratio 2.7 for 65 to 79; 6.3 if >= 80 years)

(2) obesity (odds ratio 2.1)

(3) partially (odds ratio 2.5) or totally (odds ratio 2.1) dependency

(4) operation (colectomy, small bowel resection, exploratory laparotomy)

(5) sepsis (odds ratio 4.6)

(6) bleeding disorder (odds ratio 1.7)

(7) ventilator on a ventilator within 48 hours of surgery (odds ratio 12.8)

(8) ascites (odds ratio 3.2)

(9) dialysis dependent (odds ratio 2.4)



Some of the patients would be classified as frail.

Several predictors reflect organ failures.

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