Department of Surgery, Yongin Severance Hostpital, Yongin, Korea.
Yonsei University College of Medicine, Seoul, Korea.
BMC Surg. 2024 May 17;24(1):159. doi: 10.1186/s12893-024-02452-w.
Waiting time for emergency abdominal surgery have been known to be linked to mortality. However, there is no clear consensus on the appropriated timing of surgery for gastrointestinal perforation. We investigated association between wait time and surgical outcomes in emergency abdominal surgery.
This single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs).
Mortality rates began to rise after 16 h of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 h had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality.
Although we were unable to reveal significant differences in mortality in the subgroup analysis, we were able to find an inflection point of 16 h through the RCS curve technique.
Formal consent was waived due to the retrospective nature of the study, and ethical approval was obtained from the institutional research committee of our institution (B-2110-714-107) on 6 October 2021.
众所周知，急诊腹部手术的等待时间与死亡率有关。然而，对于胃肠道穿孔的手术时机，目前尚无明确共识。我们研究了等待时间与急诊腹部手术手术结果之间的关系。
本单中心回顾性队列研究评估了 2003 年 1 月至 2021 年 9 月期间因胃肠道穿孔而行急诊手术的成年患者。风险调整的限制三次样条模型根据等待时间来预测每个死亡率的概率。死亡率开始增加的拐点用于定义早期和晚期手术。使用百分比绝对风险差异（RD，95%CI）比较倾向评分匹配的早期和晚期手术患者的结局。
等待 16 小时后，死亡率开始上升。然而，早期和晚期手术组在 30 天死亡率（11.4%比 5.7%）、重症监护病房停留时间（4.3±7.5 比 4.3±5.2 天）或总住院时间（17.4±17.0 比 24.7±23.4 天）方面没有显著差异。值得注意的是，等待超过 16 小时的患者 ICU 再入院率显著更高（8.6%比 31.4%）。急性生理和慢性健康评分 II 是 30 天死亡率的显著预测因子。
尽管我们无法在亚组分析中发现死亡率的显著差异，但我们能够通过 RCS 曲线技术找到 16 小时的拐点。
由于研究的回顾性性质，正式同意被豁免，我们机构的机构研究委员会于 2021 年 10 月 6 日批准了该研究（B-2110-714-107）。
