Sharoky Catherine E, Bailey Elizabeth A, Sellers Morgan M, Kaufman Elinore J, Sinnamon Andrew J, Wirtalla Christopher J, Holena Daniel N, Kelz Rachel R
Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, PA.
Surgery. 2017 Sep;162(3):612-619. doi: 10.1016/j.surg.2017.05.008. Epub 2017 Jul 6.
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.
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.
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]).
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.
住院期间的急诊普通外科手术情况尚未得到充分描述。我们研究了入院后较晚进行的急诊手术，以确定术后30天死亡率、术后住院时间>30天以及并发症的预测因素。
纳入美国外科医师学会国家外科质量改进计划（2011 - 2014年）中年龄>18岁、在住院第3 - 18天接受7种急诊手术之一的患者。排除入院后手术时间超过第95百分位数（>18天；n = 581）的患者。仅行探查性剖腹术（无二次手术）代表非治疗性或减压性剖腹术。采用多变量逻辑回归来确定研究结果的预测因素。
在10,093例接受急诊手术的患者中，大多数为老年人（中位年龄66岁[四分位间距：53 - 77岁]），白人，女性。术后30天死亡率为12.6%（n = 1,275）。近一半队列（40.1%）发生并发症。一小部分（6.8%）术后住院时间>30天。仅行探查性剖腹术后的死亡率特别高（>40%）。在多变量分析中，与第3 - 6天行手术相比，第11 - 18天行手术与死亡（比值比1.6[1.3 - 2.0]）、术后住院时间>30天（比值比2.0[1.6 - 2.6]）以及并发症（比值比1.5[1.3 - 1.8]）相关。仅行探查性剖腹术也与死亡相关（比值比5.4[2.8 - 10.4]）。
住院期间进行的急诊普通外科手术与高发病率和死亡率相关。急诊手术前较长的住院病程以及仅行探查性剖腹术是不良结局的预测因素。
