Harvard TH Chan School of Public Health, Boston, MA, USA; Brigham and Women's Hospital, Department of Surgery, Boston, MA, USA.
Brigham and Women's Hospital, Department of Surgery, Boston, MA, USA; Brigham and Women's Hospital Center for Surgery and Public Health, Boston, MA, USA.
Am J Surg. 2018 Nov;216(5):856-862. doi: 10.1016/j.amjsurg.2018.03.006. Epub 2018 Mar 7.
Emergency general surgery (EGS) is an independent risk factor for morbidity and mortality, and seven procedures account for 80% of the National burden of operative EGS. We aimed to characterize the excess morbidity and mortality attributable to these procedures based on the level of procedural risk.
Retrospective analysis of the ACS National Surgical Quality Improvement Project (ACS-NSQIP) database. (2005-2014). Seven EGS procedures were stratified as high risk and low risk. Primary outcomes were overall mortality, overall morbidity, major morbidity. Multivariable logistic regression was performed.
There were 619,174 patients identified. Comparing EGS to non-EGS in high-risk cases the OR for overall mortality was 1.39(1.33,1.45), overall morbidity 1.07 (0.98, 1.16), and major morbidity 1.15(1.03,1,27). In low-risk cases the OR for overall mortality was 1.03 (0.89, 1.19) overall morbidity 1.35 (1.23, 1.48), and major morbidity 2.18(1.90, 2.50).
Using a Nationally representative clinical database we identified significant heterogeneity in the outcomes of EGS depending on procedural risk. Risk stratification and benchmarking strategies need to account for the inherent heterogeneity of EGS.
急诊普通外科（EGS）是发病率和死亡率的独立危险因素，其中 7 种手术占手术性 EGS 国家负担的 80%。我们旨在根据手术风险水平，确定这些手术导致的发病率和死亡率过高的原因。
回顾性分析美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库（2005-2014 年）。将 7 种 EGS 手术分为高风险和低风险。主要结局是总死亡率、总发病率、主要发病率。采用多变量逻辑回归进行分析。
共确定了 619174 名患者。在高风险病例中，与非 EGS 相比，EGS 的总死亡率的比值比（OR）为 1.39（1.33，1.45），总发病率为 1.07（0.98，1.16），主要发病率为 1.15（1.03，1.27）。在低风险病例中，总死亡率的 OR 为 1.03（0.89，1.19），总发病率为 1.35（1.23，1.48），主要发病率为 2.18（1.90，2.50）。
使用全国代表性的临床数据库，我们发现，根据手术风险，EGS 的结果存在显著的异质性。风险分层和基准策略需要考虑 EGS 的固有异质性。
