Faculty Collaboration Database

A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform? Can J Surg 2020 Mar 27;63(2):E150-E154

Date

03/28/2020

Pubmed ID

32216251

Pubmed Central ID

PMC7828965

DOI

10.1503/cjs.019118

Scopus ID

2-s2.0-85082520532 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

BACKGROUND: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown.

METHODS: In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed.

RESULTS: A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively.

CONCLUSION: Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada.

Author List

Ball CG, Murphy P, Verhoeff K, Albusadi O, Patterson M, Widder S, Hameed SM, Parry N, Vogt K, Kortbeek JB, MacLean AR, Engels PT, Rice T, Nenshi R, Khwaja K, Minor S, Canadian Collaborative on Urgent Care Surgery (CANUCS)

Author

Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Canada
Clinical Audit
Emergencies
Female
Humans
Laparoscopy
Length of Stay
Male
Middle Aged
Patient Readmission
Postoperative Complications
Prospective Studies
Surgical Procedures, Operative