Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.
Surgeon. 2021 Jun;19(3):156-161. doi: 10.1016/j.surge.2020.04.005. Epub 2020 May 20.
Emergency general surgery (EGS) is a high-risk process and is associated with poor outcomes and high mortality. This study aimed to evaluate the service delivery factors in a tertiary referral centre which may influence patient outcomes in emergency general surgery.
Data on consecutive patients undergoing emergency laparotomy in a tertiary referral centre were prospectively collected from July 2017-July 2018. An extensive review of patient charts and IT systems was performed to extract demographic, clinical and care pathway data. Transfers for surgery from within the institution or within the centralised hospital network were recorded.
The unadjusted 30-day mortality rate in 163 patients undergoing emergency laparotomy was 13%. On multivariate analysis, 30-day mortality was significantly associated with p-POSSUM predicted mortality (p = 0.003), p-POSSUM predicted morbidity (p = 0.01), SORT mortality (p = 0.004), ICU admission (p = 0.02), ASA grade (p < 0.001) and transfer from non-surgical services (p < 0.001). 19.2% of patients were transferred from a referring hospital for emergency laparotomy. There was no association between inter-hospital transfer and 30-day mortality while increased mortality was observed in patients admitted to non-surgical services who required laparotomy (p < 0.001).
Inter-hospital transfer for emergency laparotomy was not associated with increased mortality. Increased mortality was observed in patients admitted to non-surgical services who subsequently required emergency laparotomy. Configuration of emergency general surgery services must accommodate safe and effective transfer of patients, both between and within hospitals.
急诊普通外科(EGS)是一个高风险的过程,与不良预后和高死亡率相关。本研究旨在评估三级转诊中心的服务提供因素,这些因素可能影响急诊普通外科患者的结局。
从 2017 年 7 月至 2018 年 7 月,前瞻性地收集了在三级转诊中心接受急诊剖腹手术的连续患者的数据。对患者的病历和 IT 系统进行了广泛的回顾,以提取人口统计学、临床和护理路径数据。记录了从院内或集中医院网络转来进行手术的患者。
163 例接受急诊剖腹手术的患者,未调整的 30 天死亡率为 13%。多变量分析显示,30 天死亡率与 p-POSSUM 预测死亡率(p=0.003)、p-POSSUM 预测发病率(p=0.01)、SORT 死亡率(p=0.004)、重症监护病房(ICU)入院(p=0.02)、ASA 分级(p<0.001)和非外科服务转科(p<0.001)显著相关。19.2%的患者从转诊医院转来接受急诊剖腹手术。医院间转科与 30 天死亡率之间无关联,而在需要剖腹手术的非外科服务患者中,死亡率增加(p<0.001)。
急诊剖腹手术的医院间转科与死亡率增加无关。在需要紧急剖腹手术的非外科服务患者中,死亡率增加。急诊普通外科服务的配置必须能够安全有效地转院,包括在医院之间和内部。