Impact of specific postoperative complications on the outcomes of emergency general surgery patients

McCoy, C. Cameron; Englum, Brian R.; Keenan, Jeffrey E.; Vaslef, Steven N.; Shapiro, Mark L.; Scarborough, John

doi:10.1097/ta.0000000000000611

Cited by 76 publications

(69 citation statements)

References 10 publications

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“…In contrast with other studies [26], emergent surgery was not found to be a significant risk factor in our study cohort. This could be explained by the differences in patient profiles as well as by divergence in the surgical patient population characterized by the deserving hospital, its settings and surgical management protocols and policies.…”

Section: Discussioncontrasting

confidence: 55%

“…Boni et al observed that 1.1% and 4% of patients who underwent cholecystectomies laparoscopically and with open surgery, respectively, developed SSI [25]. Furthermore, McCoy et al showed that patients who underwent emergent surgeries had an increased OR (95% CI) risk of SSI of 3.15 (2.69, 3.68) (p < 0.001) of developing an organ/ space SSI following surgery when compared to patients who underwent elective procedures [26].…”

Section: Introductionmentioning

confidence: 99%

“…The risk factors with continuous scales were dichotomized for statistical purposes. The BMI abnormality original classification included underweight (< 18.5), overweight (25)(26)(27)(28)(29)(30), class I obese (30)(31)(32)(33)(34)(35), class II obese (35)(36)(37)(38)(39)(40) and class III obese (> 40) groups as per pre-defined NSQIP BMI ranges. The altered classification classified BMI levels below 18.5 and above 25 as abnormal (under/overweight) and those between 18.5 and 25 as normal [27].…”

Section: Risk Factorsmentioning

confidence: 99%

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Development of Risk Scoring Tool to Predict Surgical Site Infections

Sampalis¹

2015

SOJS

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Development of Risk Scoring Tool to Predict Surgical Site Infections

Sampalis¹

2015

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“…Previous studies of morbidity after EGS typically describe complications in terms of their incidence or their strength of association with downstream outcomes such as mortality, hospital cost, or hospital readmission. 7–16 However, simple knowledge of the prevalence of a complication or its severity is not sufficient for being able to determine that complication’s overall impact on a given patient population. For example, a relatively common complication will have only a negligible population-level impact if it is unlikely to result in pathophysiologic compromise or extensive resource use.…”

mentioning

confidence: 99%

Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery

Scarborough

Schumacher

Pappas

et al. 2016

Journal of the American College of Surgeons

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BACKGROUND Because preoperative risk factor modification is generally not possible in the emergency setting, complication prevention represents an important focus for quality improvement in emergency general surgery (EGS). The objective of our study was to determine the overall impact that specific postoperative complications have in this patient population. STUDY DESIGN Our study sample consisted of patients from the 2012–2013 ACS-NSQIP database who underwent an EGS procedure. We used population attributable fractions (PAFs) to estimate the overall impact that each of 8 specific complications had on 30-day physiologic and resource use outcomes in our study population. The PAF represents the percentage reduction in a given outcome that would be anticipated if a complication were able to be completely prevented in our study population. Both unadjusted and risk-adjusted PAFs were calculated. RESULTS There were 79,183 patients included for analysis. The most common complications in these patients were bleeding (6.2%), incisional surgical site infection (SSI) (3.4%), pneumonia (2.7%), and organ/space SSI (2.6%). Bleeding was the complication with the greatest overall impact on mortality and end-organ dysfunction, demonstrating an adjusted PAF of 10.7% (95% CI 8.2%,13.1%, p < 0.001) and 15.9% (95% CI 13.9%, 16.7%, p < 0.001) for these respective outcomes. The only other complication with a sizeable impact on these outcomes was pneumonia (adjusted PAF of 7.9% for mortality and 13.2% for pneumonia). In contrast, complications such as urinary tract infection, venous thromboembolism, myocardial infarction, and incisional SSI had negligible impacts on these outcomes. CONCLUSIONS Our study provides a framework for the development of high-value quality initiatives in EGS.

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“…1 Primary skin closure in trauma damage control laparotomies significantly increases the risk of superficial SSIs ninefold. 2 Negative pressure wound therapy (NPWT) was developed for open or infected wounds in the early 1990s 3,4 and has become the standard of care in open wound management for general surgery and trauma. NPWT decreases wound edema and seroma formation, increases vascularity and nutrient delivery, and promotes positive mechanical wound remodeling.…”

mentioning

confidence: 99%

Comparison of a standardized negative pressure wound therapy protocol after midline celiotomy to primary skin closure and traditional open wound vacuum-assisted closure management

Regner

Forestiere

Maldonado

et al. 2018

Baylor University Medical Center Proceedings

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A negative pressure wound therapy (NPWT) protocol using Hydrofera Blue Ò bacteriostatic foam wicks and silver-impregnated foam overlay to close midline skin incisions after emergency celiotomy was compared to primary skin closure only and traditional open wound vacuum-assisted closure management as part of a quality improvement initiative. This single-institution retrospective cohort study assessed all consecutive emergency celiotomies from July 2013 to June 2014 excluding clean wounds. Included variables were demographics, wound classification, NPWT days, and surgical site occurrences (SSOs). Primary outcome was days of NPWT. Secondary outcomes included SSOs (surgical site infections, fascial dehiscence, return to operating room). Analysis used exact chisquare between categorical variables, Kruskal-Wallis for analysis of variance for ordinal and categorical variables, and Wilcoxon rank sum for total days of NPWT. One hundred fifty-eight patients underwent emergency celiotomy with primary skin closure (n D 51), open NPWT (n D 63), or the NPWT protocol (n D 44). There was no difference in American Society of Anesthesiologists Physical Status score, body mass index, wound classification, or SSO between the three groups. Total NPWT days were reduced in protocol versus open NPWT (median 3 vs 20.5 days, range 3-51 vs 3-405 days, P D 0.001). Primary skin closure and NPWT protocol had fewer patients discharged with NPWT than open NWPT (0% and 14% vs 63.5%, P < 0.0001, odds ratio D 10.7, 95% confidence interval 3.7-35.1). Primary skin closure and NPWT protocol decrease NPWT usage days and maintain low SSOs in emergency midline celiotomy incisions.

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Impact of specific postoperative complications on the outcomes of emergency general surgery patients

Abstract: Prognostic and epidemiologic study, level III.

Cited by 76 publications

References 10 publications

Development of Risk Scoring Tool to Predict Surgical Site Infections

Development of Risk Scoring Tool to Predict Surgical Site Infections

Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery

Comparison of a standardized negative pressure wound therapy protocol after midline celiotomy to primary skin closure and traditional open wound vacuum-assisted closure management

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