Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
J Surg Res. 2021 Jan;257:50-55. doi: 10.1016/j.jss.2020.07.038. Epub 2020 Aug 17.
Emergency general surgery (EGS) has high rates of morbidity, mortality, and readmission. Therefore, it might be expected that an EGS service fields many consultations for postoperative patients. However, with the known overutilization of emergency department visits for nonurgent conditions, we hypothesized most postoperative consults received by an EGS service would be nonurgent and could be appropriately managed as an outpatient.
We reviewed all EGS consults at a single urban safety net hospital over a 12-month period, screening for patients who had undergone surgery in the previous 12 mo. This included consultations from the emergency room and inpatient setting. Demographics, admission status, procedures performed, and other details were abstracted from the chart and Vizient reports. Consultation questions were categorized and then reviewed by an expert panel to determine if conditions could have been managed as an outpatient.
The EGS service received a total of 1112 consults, with 99 (9%) for a postoperative condition. Overall, 85% of postoperative consults were admitted after consultation, 19% underwent surgery and 21% underwent a procedure with gastroenterology or interventional radiology. Expert review classified slightly over one-third (36%) of consults as nonurgent.
Most postoperative consults seen at our urban safety net hospital represent true morbidity that required admission, intervention, or surgery. Despite this high acuity, one-third of postoperative consults could have been managed as an outpatient. Efforts to improve discharge instructions and set patient expectations could limit unnecessary postoperative emergency department visits.
急诊普通外科（EGS）的发病率、死亡率和再入院率都很高。因此，可以预期 EGS 服务会接到很多术后患者的咨询。然而，由于已知急诊就诊存在过度利用的情况，对于非紧急情况，我们假设 EGS 服务接收到的大多数术后咨询都属于非紧急情况，可以作为门诊患者进行适当管理。
我们回顾了一家城市医疗救助医院在 12 个月期间的所有 EGS 咨询，筛选出在过去 12 个月内接受过手术的患者。这包括来自急诊室和住院病房的咨询。从图表和 Vizient 报告中提取人口统计学、入院状态、进行的程序和其他详细信息。咨询问题进行了分类，然后由专家小组进行审查，以确定是否可以作为门诊患者进行管理。
EGS 服务共收到 1112 次咨询，其中 99 次（9%）是术后情况。总体而言，85%的术后咨询在咨询后入院，19%接受了手术，21%接受了胃肠病学或介入放射学的程序。专家审查将略多于三分之一（36%）的咨询归类为非紧急情况。
我们城市医疗救助医院的大多数术后咨询都代表了需要入院、干预或手术的真正发病率。尽管如此，三分之一的术后咨询可以作为门诊患者进行管理。努力改善出院指导和设定患者预期可以限制不必要的术后急诊就诊。
