National estimates of predictors of outcomes for emergency general surgery

Shah, Adil A.; Haider, Adil H.; Zogg, Cheryl K.; Schwartz, David R.; Haut, Elliott R.; Zafar, Syed Nabeel; Schneider, Eric B.; Velopulos, Catherine G.; Shafi, Shahid; Zafar, Hasnain; Efron, David T.

doi:10.1097/ta.0000000000000555

Cited by 151 publications

(112 citation statements)

References 24 publications

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“…In contrast to elective surgery, emergency conditions present at inconvenient hours, often without a diagnosis, with limited background information, and frequently with little time for planning. Outcomes are usually severalfold worse than after elective surgery, in terms of both morbidity and mortality. In addition, costs are considerable across the entire care pathway, with increases projected for the next few decades.…”

Section: Introductionmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2015

British Journal of Surgery

144

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Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

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Section: Introductionmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2015

British Journal of Surgery

144

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“…On the patient level, comorbid disease burden, age, race, and socioeconomic status represent some, but not all, of the potential influencers of in-hospital and postoperative outcomes. 1–3 Moving beyond the individual patient, hospital-level characteristics, such as volume, trauma-level designation, and resident participation can also impact perioperative outcomes after urgent and emergent general surgery. 4–7 The diversity of influences on surgical outcomes is further illustrated by temporal patterns seen in the quality of surgical care.…”

mentioning

confidence: 99%

Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures

et al. 2015

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Objective We hypothesized that perioperative hospital resources could overcome the “weekend effect” (WE) in patients undergoing emergent/urgent surgeries. Summary Background Data The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Methods Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Results Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P <0.001). Conclusions Specific hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

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“…[4][5][6] Adjusted mortality and cause-specific mortality rates are higher among uninsured patients than those among patients with insurance. 5,[7][8][9] Despite higher mortality and lack of preventive services, US health care policy has not been successful in systematizing care of the uninsured. The Burton-Hill Act of 1946 mandated uncompensated care from hospitals receiving government funding, but was nearly unenforced for 30 years.…”

Section: Introductionmentioning

confidence: 99%