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)
where:
• Some of the patients would be classified as frail.
• Several predictors reflect organ failures.
