Early postoperative factors associated with in-hospital mortality after emergency noncardiac surgery: A Japanese nationwide registry-based intensive care unit cohort study

Emergency noncardiac surgery carries a substantial risk of death, yet factors influencing outcomes immediately after surgery remain unclear. We conducted a multicenter retrospective cohort study of adults admitted to intensive care units immediately after emergency noncardiac surgery between January 2020 and December 2023, using data from the nationwide Japanese Intensive Care Patient Database (JIPAD) registry. Among 18,781 patients, 2,233 (11.9%) died during hospitalization. Independent predictors of mortality included older age (≥65 years; adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.69-2.13), metastatic cancer (aOR 2.60, 95% CI 2.07-3.26), and physiological abnormalities within 24 hours of admission, specifically low Glasgow Coma Scale score (≤8; aOR 3.38, 95% CI 2.96-3.87) and elevated lactate (≥2 mmol/L; aOR 1.58, 95% CI 1.43-1.76). Hypotension, tachycardia, and renal dysfunction were also associated with mortality. These associations remained consistent across age groups and sensitivity analyses that excluded low-risk surgical categories and addressed missing data. In this nationwide cohort, the in-hospital mortality rate was 11.9% after emergency noncardiac surgery. Readily obtainable postoperative variables within the first 24 hours of ICU admission may support prompt risk stratification and help identify high-risk patients who require intensified monitoring.