From the Division of General Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont. (Vogt, Allen, Murphy, Parry); the Division of General Surgery, Department of Surgery, William Osler Health System, Brampton, Ont. (Van Heest, Saleh); the Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Widder); the Divisions of General Surgery and Critical Care Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, N.S. (Minor, Lacoul); the Department of Surgery Hamilton General Hospital, McMaster University, Hamilton, Ont. (Engels, Nenshi, Meschino); the Division of Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, B.C. (Joos, Laane, Hameed); and the Divisions of Surgery and Oncology, University of Calgary, Calgary, Alta. (Ball).
Can J Surg. 2020 Sep-Oct;63(5):E435-E441. doi: 10.1503/cjs.011219.
Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada.
This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged ≥ 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality.
A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11%) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and débridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall inhospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age ( = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre ( = 0.001).
This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement.
大多数关于急症普通外科（EGS）的文献都研究了阑尾和胆道疾病；然而，EGS 外科医生还需要处理许多其他复杂的病症。本研究旨在描述加拿大各地此类病症的手术负担。
这是一项多中心回顾性队列研究，于 2014 年在加拿大 7 个中心评估了 EGS 患者。纳入接受非择期手术干预的非胆道、非阑尾疾病的成年患者（年龄≥18 岁）。收集的数据包括患者的人口统计学特征、诊断、手术细节、并发症和住院时间。使用逻辑回归来确定发病率和死亡率的预测因素。
共纳入 2595 例患者，中位年龄为 60 岁（四分位间距 46-73 岁）。最常见的主要诊断是小肠梗阻（16%）、疝（15%）、恶性肿瘤（11%）和肛周疾病（9%）。最常进行的手术是肠切除术（30%）、疝修补术（15%）、粘连松解术（11%）和皮肤和软组织感染清创术（10%）。总共 47%的病例在夜间完成（下午 5 点至早上 8 点之间）。住院死亡率为 8%。33%的患者发生并发症，独立预测因素包括年龄增长（p = 0.001）、美国麻醉医师协会评分增加（p = 0.02）和从其他中心转来（p = 0.001）。
本研究描述了加拿大非胆道、非阑尾 EGS 手术干预的流行病学。加拿大外科医生正在进行大量的 EGS 手术，EGS 服务治疗的病症与发病率和死亡率显著增加相关。本研究的结果将用于指导未来的研究工作，并为质量改进设定基准。
