Faculty Collaboration Database

Outcomes of hospitalized patients undergoing emergency general surgery remote from admission. Surgery 2017 Sep;162(3):612-619

Date

07/12/2017

Pubmed ID

28689604

DOI

10.1016/j.surg.2017.05.008

Scopus ID

2-s2.0-85021811949 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications.

METHODS: Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes.

RESULTS: Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]).

CONCLUSION: Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only.

Author List

Sharoky CE, Bailey EA, Sellers MM, Kaufman EJ, Sinnamon AJ, Wirtalla CJ, Holena DN, Kelz RR

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

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

Age Factors
Aged
Cause of Death
Cohort Studies
Databases, Factual
Emergency Treatment
Female
Follow-Up Studies
General Surgery
Hospital Mortality
Hospitalization
Humans
Length of Stay
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patient Admission
Postoperative Complications
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Sex Factors
Surgical Procedures, Operative