From the Department of Surgery (Z.G.H., M.P.J., J.M.H., E.G., Z.C., A.S., A.H.H.), Brigham and Women's Hospital, Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery (J.W.S.), University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine (E.G.), Brigham and Women's Hospital, Boston, Massachusetts; and The Dean's Office, Medical College (A.H.H.), Aga Khan University, Karachi, Pakistan.
J Trauma Acute Care Surg. 2021 Apr 1;90(4):685-693. doi: 10.1097/TA.0000000000003074.
Nearly 4 million Americans present to hospitals with conditions requiring emergency general surgery (EGS) annually, facing significant morbidity and mortality. Unlike elective surgery and trauma, there is no dedicated national quality improvement program to improve EGS outcomes. Our objective was to estimate the number of excess deaths that could potentially be averted through EGS quality improvement in the United States.
Adults with the American Association for the Surgery of Trauma-defined EGS diagnoses were identified in the Nationwide Emergency Department Sample 2006 to 2014. Hierarchical logistic regression was performed to benchmark treating hospitals into reliability adjusted mortality quintiles. Weighted generalized linear modeling was used to calculate the relative risk of mortality at each hospital quintile, relative to best-performing quintile. We then calculated the number of excess deaths at each hospital quintile versus the best-performing quintile using techniques previously used to quantify potentially preventable trauma deaths.
Twenty-six million EGS patients were admitted, and 6.5 million (25%) underwent an operation. In-hospital mortality varied from 0.3% to 4.1% across the treating hospitals. Relative to the best-performing hospital quintile, an estimated 158,177 (153,509-162,736) excess EGS deaths occurred at lower-performing hospital quintiles. Overall, 47% of excess deaths occurred at the worst-performing hospitals, while 27% of all excess deaths occurred among the operative cohort.
Nearly 200,000 excess EGS deaths occur across the United States each decade. A national initiative to enable structures and processes of care associated with optimal EGS outcomes is urgently needed to achieve "Zero Preventable Deaths after Emergency General Surgery."
Care management, level IV.
每年有近 400 万美国人因需要急诊普通外科（EGS）治疗的疾病而前往医院就诊，他们面临着较高的发病率和死亡率。与择期手术和创伤不同，美国没有专门的国家质量改进计划来改善 EGS 治疗结果。我们的目的是估计通过 EGS 质量改进，美国可能避免多少例额外死亡。
在 2006 年至 2014 年的全国急诊部样本中，我们确定了美国外科创伤协会定义的 EGS 诊断的成年人。采用分层逻辑回归对治疗医院进行基准测试，将其分为可靠性调整死亡率五分位数。采用加权广义线性模型计算每个医院五分位数相对于最佳五分位数的死亡率相对风险。然后，我们使用先前用于量化潜在可预防创伤死亡的技术，计算每个医院五分位数相对于最佳五分位数的超额死亡人数。
共有 2600 万例 EGS 患者入院，其中 650 万例（25%）接受了手术。各治疗医院的院内死亡率从 0.3%到 4.1%不等。与最佳表现的医院五分位数相比，在表现较差的医院五分位数中，估计有 158177 例（153509-162736）EGS 死亡是多余的。总体而言，47%的额外死亡发生在表现最差的医院，而 27%的额外死亡发生在手术患者中。
美国每十年发生近 20 万例 EGS 额外死亡。迫切需要开展一项全国性倡议，以建立与最佳 EGS 结果相关的结构和护理流程，从而实现“急诊普通外科后零例可预防死亡”。
护理管理，四级。
