Department of Surgery, University of Massachusetts Chan School of Medicine, Rachel Schneider, 514 Plantation Street, Worcester, MA, 01605, USA.
Surg Endosc. 2024 Mar;38(3):1576-1582. doi: 10.1007/s00464-023-10600-1. Epub 2024 Jan 5.
Perforated peptic ulcer disease (PPUD) has a prevalence of 0.004-0.014% with mortality of 23.5% (Tarasconi et al. in World J Emerg Surg 15(PG-3):3, 2020). In this single center study, we examined the impact associated with patient transfer from outside facilities to our center for definitive surgical intervention (exploratory laparotomy).
Using EPIC report workbench, we identified 27 patients between 2018 and 2021 undergoing exploratory laparotomy with a concurrent diagnosis of peptic ulcer disease, nine of which were transferred to our institution for care. We queried this population for markers of disease severity including mortality, length of stay, intensive care unit (ICU) length of stay, and readmission rates. Manual chart reviews were performed to examine these outcomes in more detail and identify patients who had been transferred to our facility for surgery from an outside hospital.
A total of 27 patients were identified undergoing exploratory laparotomy for definitive treatment of PPUD. The majority of patients queried underwent level A operations, the most urgent level of activation. In our institution, a Level A operation needs to go to the operating room within one hour of arrival to the hospital. Average mortality for this patient population was 14.8%. The readmission rate was 40.1%, and average length of ICU stay post-operatively was 16 days, with 83% of non-transfer patients requiring ICU admission and 100% of transfer patients requiring ICU admission, although this was not found to be statistically significant. Average length of hospital stay was 27 days overall. For non-transfer patients and transfer patients, LOS was 20 days and 41 days, respectively, which was statistically significant by one-sided t-test (p = 0.05).
Patients transferred for definitive care of PPUD in a population otherwise notable for high mortality and high readmission rates: their average length of stay compared to non-transfer patients was over twice the length, which was statistically significant. Transferred patients also had higher rates of ICU care requirement although this was not statistically significant. Further inquiry to identify modifiable variables to facilitate the care of transferred patients is warranted, especially in the context of improving quality metrics known to enhance patient outcomes, satisfaction, and value.
穿孔性消化性溃疡病（PPUD）的患病率为 0.004-0.014%，死亡率为 23.5%（Tarasconi 等人在《世界急诊外科学杂志》15（PG-3）：3，2020 年）。在这项单中心研究中，我们检查了将患者从外部设施转移到我们中心进行确定性手术干预（剖腹探查）相关的影响。
我们使用 EPIC 报告工作台，确定了 2018 年至 2021 年间接受剖腹探查术且同时诊断为消化性溃疡病的 27 名患者，其中 9 名患者被转移到我们机构进行治疗。我们对该人群进行了疾病严重程度标志物的查询，包括死亡率、住院时间、重症监护病房（ICU）住院时间和再入院率。进行了手动图表审查，以更详细地检查这些结果，并确定已从外部医院转移到我们设施进行手术的患者。
共确定了 27 名患者接受剖腹探查术以明确治疗 PPUD。被询问的大多数患者接受了 A 级手术，这是最紧急的激活级别。在我们机构，A 级手术需要在到达医院后 1 小时内进入手术室。该患者人群的平均死亡率为 14.8%。再入院率为 40.1%，术后 ICU 住院时间平均为 16 天，非转院患者中有 83%需要 ICU 入院，转院患者中有 100%需要 ICU 入院，但这并没有统计学意义。总体而言，平均住院时间为 27 天。对于非转院患者和转院患者，LOS 分别为 20 天和 41 天，单侧 t 检验发现这有统计学意义（p=0.05）。
在死亡率和再入院率均较高的人群中，为明确治疗 PPUD 而转院的患者：与非转院患者相比，他们的平均住院时间延长了一倍以上，这具有统计学意义。转院患者的 ICU 护理需求也较高，但这没有统计学意义。需要进一步调查以确定可改变的变量，以方便转院患者的护理，特别是在提高已知可改善患者预后、满意度和价值的质量指标方面。
