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Recurring emergency general surgery

Characterizing a vulnerable population

Lunardi, Nicole, MSPH; Mehta, Ambar, MD, MPH; Ezzeddine, Hiba, MD; Canner, Joseph K., MHS; Hamidi, Mohammad, MD; Jehan, Faisal, MD; Joseph, Bellal A., MD; Nathens, Avery B., MD, MPH, PhD; Efron, David T., MD; Diaz, Jose Jr, MD; Sakran, Joseph V., MD, MPH, MPA

Journal of Trauma and Acute Care Surgery: March 2019 - Volume 86 - Issue 3 - p 464–470
doi: 10.1097/TA.0000000000002151
ORIGINAL ARTICLES
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BACKGROUND Limited data exist for long-term outcomes after emergency general surgeries (EGSs) in the United States. This study aimed to characterize the incidence of inpatient readmissions and additional operations within 6 months of an EGS procedure.

METHODS In this retrospective observational study, we identified adults (≥18 years old) undergoing one of seven common EGS procedures (appendectomies, cholecystectomies, small bowel resections, large bowel resections, control of gastrointestinal [GI] ulcers and bleeding, peritoneal adhesiolysis, and exploratory laparotomies) who were discharged alive in the 2010–2015 National Readmissions Database. Outcomes included the rates of all-cause inpatient readmissions and of undergoing a second EGS procedure, both within 6 months. Multivariable logistic regression models identified risk factors of reoperation, adjusting for patient, clinical, and hospital factors.

RESULTS Of 706,678 patients undergoing an EGS procedure 131,291 (18.6%) had an inpatient readmission within 6 months. Among those readmitted, 15,178 (11.6%) underwent a second EGS procedure, occurring at a median of 45 days (interquartile range, 15–95). After adjustment, notable predictors of reoperation included male sex (adjusted odds ratio [aOR], 1.06 [95% confidence interval, 1.01–1.10]); private, nonprofit hospitals (aOR, 1.09 [1.02–1.17]); private, investor-owned hospitals (aOR, 1.09 [1.00–1.85]); discharge to short-term hospital (aOR, 1.35 [1.04–1.74]); discharge with home health care (aOR, 1.19 [1.13–1.25]); and index procedure of control of GI ulcer and bleeding (aOR, 9.38 [8.75–10.05]), laparotomy (aOR, 7.62 [6.92–8.40]), or large bowel resection (aOR, 6.94 [6.44–7.47]).

CONCLUSION One fifth of patients undergoing an EGS procedure had an inpatient readmission within 6 months, where one in nine of those underwent a second EGS procedure. As half of all second EGS procedures occurred within 6 weeks of the index procedure, identifying patients with the highest health care needs (index procedure type and discharge needs) may identify patients at risk for subsequent reoperation in nonemergency settings.

LEVEL OF EVIDENCE Epidemiological, level III.

From the School of Medicine (N.L.), Johns Hopkins University, Baltimore, Maryland; Department of Surgery (A.M.), NewYork-Presbyterian Columbia University Medical Center, New York, New York; Department of Surgery (H.E., J.K.C., D.T.E., J.V.S.), Johns Hopkins Hospital, Baltimore, Maryland; Department of Surgery (M.H., F.J., B.A.J.), University of Arizona College of Medicine, Tucson, Arizona; Department of Surgery (A.B.N.), University of Toronto, Toronto, Ontario, Canada; and Department of Surgery (J.D.J.), R Adams Cowley Shock Trauma, School of Medicine, University of Maryland, Maryland.

Submitted: September 7, 2018, Revised: October 25, 2018, Accepted: November 11, 2018, Published online: November 28, 2018.

This study was presented at the 77th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery, September 26–29, 2018, in San Diego, California.

Address for reprints: Joseph V. Sakran, MD, MPH, MPA, Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Sheikh Zayed Tower, Suite 61078, Baltimore, MD 21287; email: jsakran1@jhmi.edu.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2019 Lippincott Williams & Wilkins, Inc.