Outcomes of hospitalized patients undergoing emergency general surgery remote from admission

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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.

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