From the Division of Trauma and General Surgery, University of Pittsburgh Medical Center (A.B., R.H., A.B.P., R.M.F.), Pittsburgh, Pennsylvania; Division of Trauma and Acute Care Surgery, Dartmouth Hitchcock Medical Center (A.B.), Lebanon, New Hampshire; and Department of Surgery, University of Mississippi Medical Center (M.E.K.), Jackson, Mississippi.
J Trauma Acute Care Surg. 2019 Oct;87(4):774-781. doi: 10.1097/TA.0000000000002411.
Medical intensive care unit (MICU) patients develop acute surgical processes that require operative intervention. There are limited data addressing outcomes of emergency general surgery (EGS) in this population. The aim of our study was to characterize the breadth of surgical consults from the MICU and assess mortality after abdominal EGS cases.
All MICU patients with an EGS consult in an academic medical center between January 2010 and 2016 were identified from an electronic medical record-based registry. Charts were reviewed to determine reason for consult, procedures performed, and to obtain additional clinical data. A multivariate logistic regression was used to determine patient factors associated with patient mortality.
Of 911 MICU patients seen by our service, 411(45%) required operative intervention, with 186 patients undergoing an abdominal operation. The postoperative mortality rate after abdominal operations was 37% (69/186), significantly higher than the mortality of 16% (1833/11192) for all patients admitted to the MICU over the same period (p < 0.05). Damage-control procedures were performed in 64 (34%) patients, with 46% mortality in this group. The most common procedures were bowel resections, with mortality of 42% (28/66) and procedures for severe clostridium difficile, mortality of 38% (9/24). Twenty-seven patients met our definition of surgical rescue, requiring intervention for complications of prior procedures, with mortality of 48%. Need for surgical rescue was associated with increased admission mortality (odds ratio, 13.07; 95% confidence interval, 2.86-59.77). Twenty-six patients had pathology amenable to surgical intervention but did not undergo operation, with 100% mortality. In patients with abdominal pathology at the time of operation, in-hospital delay was associated with increased mortality (odds ratio, 5.13; 95% confidence interval, 1.11-23.77).
Twenty percent of EGS consults from the MICU had an abdominal process requiring an operative intervention. While the MICU population as a whole has a high baseline mortality, patients requiring abdominal surgical intervention are an even higher risk.
Prognostic and epidemiological, level III.
医疗重症监护病房（MICU）的患者会出现需要手术干预的急性外科疾病。关于该人群中紧急普通外科（EGS）的结果，数据有限。我们研究的目的是描述从 MICU 进行的外科会诊的范围，并评估腹部 EGS 病例后的死亡率。
从 2010 年至 2016 年，我们从一家学术医疗中心的电子病历登记处确定了所有在 MICU 进行 EGS 会诊的患者。对病历进行了回顾，以确定会诊的原因、进行的手术以及获取其他临床数据。采用多变量逻辑回归来确定与患者死亡率相关的患者因素。
在我们的服务中，911 名 MICU 患者中有 411 名（45%）需要手术干预，其中 186 名患者接受了腹部手术。腹部手术后的死亡率为 37%（69/186），明显高于同期 MICU 中所有患者的 16%（1833/11192）（p<0.05）。64 名（34%）患者进行了损伤控制性手术，该组的死亡率为 46%。最常见的手术是肠切除术，死亡率为 42%（28/66），严重梭状芽胞杆菌手术，死亡率为 38%（9/24）。27 名患者符合我们的外科救援定义，需要干预先前手术的并发症，死亡率为 48%。需要外科救援与入院死亡率增加相关（比值比，13.07；95%置信区间，2.86-59.77）。26 名患者有适合手术干预的病理，但未进行手术，死亡率为 100%。在手术时存在腹部病变的患者中，住院时间延迟与死亡率增加相关（比值比，5.13；95%置信区间，1.11-23.77）。
MICU 中 20%的 EGS 会诊涉及需要手术干预的腹部疾病。尽管 MICU 人群整体死亡率较高，但需要腹部外科干预的患者风险更高。
预后和流行病学，III 级。
