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The excess morbidity and mortality of emergency general surgery

Havens, Joaquim M. MD; Peetz, Allan B. MD; Do, Woo S.; Cooper, Zara MD, MSC; Kelly, Edward MD; Askari, Reza MD; Reznor, Gally MS; Salim, Ali MD

Journal of Trauma and Acute Care Surgery: February 2015 - Volume 78 - Issue 2 - p 306–311
doi: 10.1097/TA.0000000000000517
Original Articles
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BACKGROUND Emergency general surgery (EGS) carries a disproportionate burden of risk from medical errors, complications, and death compared with non-EGS (NEGS). Previous studies have been limited by patient and procedure heterogeneity but suggest worse outcome in EGS patients because of preoperative risk factors. The aim of this study was to quantify the excess burden of morbidity and mortality associated with EGS by controlling for patient-specific factors. We hypothesized that EGS is an independent risk factor for morbidity and mortality.

METHODS We retrospectively analyzed data from the American College of Surgeons-National Surgical Quality Improvement Program. Fourteen procedures common to both EGS and NEGS from 2008 through 2012 were included. Patients were stratified based on emergency status. The primary outcome was death within 30 days of operation. Secondary outcomes were postoperative complications. Variables from the American College of Surgeons-National Surgical Quality Improvement Program preoperative risk assessment were analyzed. χ2 and Wilcoxon signed-rank tests were used to compare variables. Multivariate logistic regression was used to identify independent risk factors for mortality and complications.

RESULTS Of 66,665 patients, 24,068 were EGS and 42,597 were NEGS. Mortality was 12.50% for EGS patients and 2.66% for NEGS patients (p < 0.0001). Major complications occurred in 32.80% of EGS patients and 12.74% of NEGS patients (p < 0.0001). When preoperative variables and procedure type were controlled, EGS was independently associated with death (odds ratio, 1.39; p = 0.029) and major complications (odds ratio, 1.31; p = 0.001).

CONCLUSION EGS is an independent risk factor for death and postoperative complications. The excess morbidity and mortality of EGS are not fully explained by preoperative risk factors, making EGS an excellent target for quality improvement projects.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.

From the Division of Trauma, Burns and Surgical Critical Care, (J.M.H., A.B.P., W.S.D., Z.C., E.K., R.A., A.S.), and Center for Surgery and Public Health, (J.M.H., Z.C., G.R., A.S.), Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts.

Submitted: August 17, 2014, Revised: October 24, 2014, Accepted: October 27, 2014.

This study was presented as a Quick Shot at the 73rd annual meeting of the American Association for the Surgery of Trauma, September 10–13, 2014, in Philadelphia, Pennsylvania.

Address for reprints: Joaquim M. Havens, MD, Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; email: jhavens@partners.org.

© 2015 Lippincott Williams & Wilkins, Inc.