Assessment of emergency general surgery care based on formally developed quality indicators

Ingraham, Angela M.; Nathens, Avery B.; Peitzman, Andrew B.; Bode, Allison; Dorlac, Gina R.; Dorlac, Warren C.; Miller, Preston R.; Sadeghi, Mahsa; Wasserman, Deena D.; Bilimoria, Karl Y.

doi:10.1016/j.surg.2017.03.025

Cited by 26 publications

(14 citation statements)

References 25 publications

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“…Similarly, this study emphasises the need for effective governance for EAS. National audits implemented in the UK8 and Australia29 reduced mortality rates in emergency general surgery and a series of quality benchmarks or key performance indicators have been proposed 30 31. Implementation of a prospective, NELA-like audit process could allow for analysis of specific factors contributing to improved outcomes in high-volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.Setting24 public hospitals providing EAS services.Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250–449) and high (450+) volume and surgical teams with low (<30), medium (30–59) and high (60+) volume during the study period were also estimated.ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

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Section: Discussionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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“…Emergency surgery is a well-known risk factor [8][9][10][11][12]. It increases the operative mortality rate from three to as many as 10 times [10].…”

Section: Discussionmentioning

confidence: 99%

Estimation of risk factors of early postoperative mortality in elderly patients who are subjected to emergency operations of the gastrointestinal tract

et al. 2020

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Introduction/Objective. The elderly (age ? 65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The objective of the paper was to determine the intra-hospital mortality rate in elderly patients undergoing emergency gastrointestinal surgical procedures. Methods. 914 elderly patients (> 65 years old) were examined, divided into two groups: emergency and elective surgery patients, treated for diseases (benign and malignant) of the stomach, duodenum, small intestine and colon. The patients were divided into four age groups and five American Society of Anesthesiologists (ASA) groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administering transfusion, and the occurrence of surgical complications during hospitalization. Results. The mortality rate among elderly patients was 17.8%. The univariate analysis in EGS patients revealed that gastro-duodenal surgical interventions (p < 0.001), ASA ? 3 score (p < 0.001), heart, lung, kidney diseases, and postoperative complications (p < 0.001), as well as the white cell count > 10,000/mm3 (p = 0.043) were independent risk factors for mortality. In the multivariate analysis, in EGS patients, the significant risk factors for mortality were gastric surgical interventions (p = 0.001), ASA score of 4 (p < 0.001), heart and kidney disease (p ? 0.001), and white cell count > 10,000/mm3 (p = 0.039). Conclusion. The characterization of independent validated risk indicators for mortality in those patients is essential and may lead to an efficient specific workup, which constitutes a necessary step towards developing a dedicated score for elderly patients.

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“…In our study none of the age groups represented significant risk factors in early postoperative mortality (p=0.922). Emergency surgery is a well-known risk factor [4]. It increases the operative mortality rate from 3 to as many as 10 times [5].…”

Section: Discussionmentioning

confidence: 99%

Estimation of Risk Factors of Early Postoperative Mortality in Elderly Patients Who Are Subjected to Gastric Surgical Procedures

Pešić

Nestorović²,

Pecić³

et al. 2019

FU Med Biol

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The use of screening programms in elderly population (age ≥65 years) comprises an increasing proportion of patients undergoing emergency general surgery (EGS) procedures nowadays. The aim was to determine the intra-hospital mortality rate in elderly patients undergoing gastric surgical procedures. 108 elderly patients (≥65 years old) were examined, divided into two groups: deceased and surviving surgical patients, treated for diseases (benign and malignant) of the stomach. The patients were divided into four age groups and five ASA groups, taking into account the presence of chronic diseases, the values of some laboratory parameters, administered transfusion and the occurrence of surgical complications during hospitalization. The mortality rate among elderly patients was 28.7%. The significant risk factors for mortality were: emergency surgery (p < 0.001), bleeding gastric ulcer operations (p = 0.042), lung (p = 0.003), kidney (p < 0.001), heart (p = 0.025) diseases, ASA score of 4 or higher (p < 0.001), serum levels (higher after two times measurement) of creatinine, haemoglobin, CRP, PCT and glycemia (p < 0.001). In order to improve medical treatment, the determination of independent validated risk indicators for mortality in elderly patients might lead to developing a dedicated scoring system.

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Assessment of emergency general surgery care based on formally developed quality indicators

Cited by 26 publications

References 25 publications

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

Estimation of risk factors of early postoperative mortality in elderly patients who are subjected to emergency operations of the gastrointestinal tract

Estimation of Risk Factors of Early Postoperative Mortality in Elderly Patients Who Are Subjected to Gastric Surgical Procedures

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