Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA.
Am Surg. 2024 Oct;90(10):2447-2456. doi: 10.1177/00031348241248796. Epub 2024 Apr 24.
We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR.
A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression.
Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR.
Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications.
我们最近发现，与未再入院的患者相比，接受 EGS 手术后再入院的患者死亡率高出 4 倍。了解再入院后死亡的相关因素对于改善 EGS 患者的预后至关重要。我们旨在确定导致 EGS 再入院后抢救失败（FTR）的风险因素。我们假设，EGS 再入院后死亡的大多数是由于 FTR。
使用 NSQIP 数据库 2013-2019 进行回顾性队列研究。确定了在术后 30 天内再次入院的 9 种紧急/紧急手术中的 1 种患者，这些患者占 EGS 疾病负担的 80%。将手术分为低风险和高风险。分析的患者特征包括年龄、性别、BMI、ASA 评分合并症、术后并发症、虚弱和 FTR。通过单变量和多变量逻辑回归评估人群与死亡率和 FTR 相关的风险因素。
在 312862 例 EGS 病例中，有 16306 例需要再次入院。其中，10748 例（3.4%）发生术后并发症。再入院后的总体死亡率为 2.4%，其中 90.6%的死亡归因于 FTR。虚弱、高风险手术、肺部并发症、急性肾损伤、脓毒症和需要再次手术增加了 FTR 的风险。
EGS 再入院后发生并发症的死亡率很高。通过实施早期识别和干预或预防感染、呼吸和肾脏并发症的措施，可以最大限度地减少 FTR 的影响。
