Comparison of Hospital Performance in Emergency Versus Elective General Surgery Operations at 198 Hospitals

Ingraham, Angela M.; Cohen, Mark E.; Raval, Mehul V.; Ko, Clifford Y.; Nathens, Avery B.

doi:10.1016/j.jamcollsurg.2010.09.026

Cited by 133 publications

(96 citation statements)

References 19 publications

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“…5,17 The ELN data on the procedural distribution of emergency laparotomies should inform emergency surgery workforce planning. Colorectal procedures are most common, followed by procedures classified as general surgical, over half of which involve surgery to the small bowel.…”

Section: Discussionmentioning

confidence: 99%

Current UK practice in emergency laparotomy

Barrow¹,

Anderson²,

Varley³

et al. 2013

annals

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on behalf of the UK Emergency Laparotomy Network ABStRAct INTRODUCTION Emergency laparotomy is a common procedure, with 30,000-50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality. METHODS Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded. RESULTS Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. 'True' emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation. CONCLUSIONS This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.

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Section: Discussionmentioning

confidence: 99%

Current UK practice in emergency laparotomy

Barrow¹,

Anderson²,

Varley³

et al. 2013

annals

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show abstract

“…When preparing for surgery, complete procedure sets for anaesthesia reduce morbidity and mortality. 12 If the testicle is determined to be irreversibly damaged, it does not require immediate surgery and anaesthesia; so, mortality and morbidity can be reduced. In addition, during surgery, the surgeon subjectively evaluates the testicle intraoperatively for reperfusion.…”

Section: Introductionmentioning

confidence: 99%

Role of diffusion weighted magnetic resonance imaging in a rat model of testicular torsion

Ufuk

Herek²,

Herek³

et al. 2016

The British Journal of Radiology

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“…6 The National Surgical Quality Improvement Program database, including more than 470,000 procedures at 198 hospitals over a fouryear period, suggests that American hospitals with low rates of mortality for elective procedures may also have high rates of mortality for emergency surgeries. 7 Variability in outcomes reflects variable processes of surgical care. Results from one study identified variability in postoperative critical care facilities and by senior surgeons and anesthesiologists involved in high-risk cases.…”

Section: Discussionmentioning

confidence: 99%

Emergency Error

2015

AORN Journal

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Comparison of Hospital Performance in Emergency Versus Elective General Surgery Operations at 198 Hospitals

Cited by 133 publications

References 19 publications

Current UK practice in emergency laparotomy

Current UK practice in emergency laparotomy

Role of diffusion weighted magnetic resonance imaging in a rat model of testicular torsion

Emergency Error

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