Havens Joaquim M, Peetz Allan B, Do Woo S, Cooper Zara, Kelly Edward, Askari Reza, Reznor Gally, Salim Ali
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.
J Trauma Acute Care Surg. 2015 Feb;78(2):306-11. doi: 10.1097/TA.0000000000000517.
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.
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. χ and Wilcoxon signed-rank tests were used to compare variables. Multivariate logistic regression was used to identify independent risk factors for mortality and complications.
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).
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.
Prognostic/epidemiologic study, level III.
与非急诊普通外科手术（NEGS）相比，急诊普通外科手术（EGS）在医疗差错、并发症和死亡方面承担着不成比例的风险负担。既往研究因患者和手术的异质性而受到限制，但提示由于术前危险因素，EGS患者的预后更差。本研究的目的是通过控制患者特异性因素来量化与EGS相关的额外发病和死亡负担。我们假设EGS是发病和死亡的独立危险因素。
我们回顾性分析了美国外科医师学会-国家外科质量改进计划的数据。纳入了2008年至2012年EGS和NEGS共有的14种手术。患者根据急诊状态进行分层。主要结局是术后30天内死亡。次要结局是术后并发症。分析了美国外科医师学会-国家外科质量改进计划术前风险评估的变量。采用χ检验和Wilcoxon符号秩检验比较变量。多因素logistic回归用于确定死亡和并发症的独立危险因素。
66665例患者中，24068例为EGS患者，42597例为NEGS患者。EGS患者的死亡率为12.50%，NEGS患者为2.66%（p<0.0001）。32.80%的EGS患者发生了严重并发症，NEGS患者为12.74%（p<0.0001）。当控制术前变量和手术类型时，EGS与死亡（比值比，1.39；p=0.029）和严重并发症（比值比，1.31；p=0.001）独立相关。
EGS是死亡和术后并发症的独立危险因素。EGS额外的发病和死亡不能完全由术前危险因素解释，这使得EGS成为质量改进项目的一个极佳目标。
预后/流行病学研究，III级。
