Risk factors for postoperative mortality and morbidities in emergency surgeries

Matsuyama, Tomonori; Iranami, Hiroshi; Fujii, Keisuke; Inoue, Masumi; Nakagawa, Reiko; Kawashima, Kohei

doi:10.1007/s00540-013-1639-z

Cited by 38 publications

(38 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the study cohort, the mean (SD) age at hospital admission was 56.6 (14.2) years. Most patients were male (64%) and [10][11][12][13][14][15][16][17][18][19][20]. Patient characteristics of the study cohort were stratified according to 90-day mortality ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…increased morbidity and mortality are not fully understood, but medical comorbidities and physiological derangements are likely to be contributing factors. [10][11][12][13] Although surgical risk calculation tools such as the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator are used to gain an objective sense of surgical risk stratification, such tools have yet to be comprehensively studied in this patient population and do not include the use of liver disease-specific assessment tools such as the MELD score in the prediction of outcomes among patients with CLD undergoing EGS. 14 We hypothesized that among patients with CLD who underwent EGS and were treated in the ICU, the MELD score would independently be associated with mortality.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Not only the time to surgery influences the outcomes, but shorter operative times of emergency surgeries are also associated with less postoperative complications [37]. Matsuyama et al reported that the mortality and morbidity are significantly lower if emergency surgeries in adults were completed within 120 min, and Kaushal-Deep et al reports better outcomes if operative times are less than 100 min for pediatric emergency surgeries [37,38]. In severely physiologically compromised trauma patients, the damage control strategy is indicated if the operative time would be longer than 90 min [39].…”

Section: Discussionmentioning

confidence: 99%

“…However, since most NSTI patients are severely physiologically compromised, short and efficient debridements might be recommended, as a major difference in mortality rate was noted between the published results of patients with an operating time shorter and longer than 90 min. The risk at more postoperative complications associated with longer operative times should be considered when skin-sparing debridement for NSTIs is contemplated [37,40]. Therefore, the clinical condition of the patient should determine the course of actions and surgical strategy.…”

Section: Discussionmentioning

confidence: 99%

Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Background: Although the phrase "time is fascia" is well acknowledged in the case of necrotizing soft tissue infections (NSTIs), solid evidence is lacking. The aim of this study is to review the current literature concerning the timing of surgery in relation to mortality and amputation in patients with NSTIs. Methods: A systematic search in PubMed/MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Controlled Register of Trials (CENTRAL) was performed. The primary outcomes were mortality and amputation. These outcomes were related to the following time-related variables: (1) time from onset symptoms to presentation; (2) time from onset symptoms to surgery; (3) time from presentation to surgery; (4) duration of the initial surgical procedure. For the meta-analysis, the effects were estimated using random-effects meta-analysis models.Result: A total of 109 studies, with combined 6051 NSTI patients, were included. Of these 6051 NSTI patients, 1277 patients died (21.1%). A total of 33 studies, with combined 2123 NSTI patients, were included for quantitative analysis. Mortality was significantly lower for patients with surgery within 6 h after presentation compared to when treatment was delayed more than 6 h (OR 0.43; 95% CI 0.26-0.70; 10 studies included). Surgical treatment within 6 h resulted in a 19% mortality rate compared to 32% when surgical treatment was delayed over 6 h. Also, surgery within 12 h reduced the mortality compared to surgery after 12 h from presentation (OR 0.41; 95% CI 0.27-0.61; 16 studies included). Patient delay (time from onset of symptoms to presentation or surgery) did not significantly affect the mortality in this study. None of the time-related variables assessed significantly reduced the amputation rate. Three studies reported on the duration of the first surgery. They reported a mean operating time of 78, 81, and 102 min with associated mortality rates of 4, 11.4, and 60%, respectively.Conclusion: Average mortality rates reported remained constant (around 20%) over the past 20 years. Early surgical debridement lowers the mortality rate for NSTI with almost 50%. Thus, a sense of urgency is essential in the treatment of NSTI.

show abstract

“…Many studies have shown an association between EGS and negative out comes, including higher rates of major complications and death. [3][4][5][6][7][8][9] Compared to patients undergoing elective oper ations, those undergoing emergency open gastrointestinal surgery are up to 5 times more likely to die within 30 days of their operation; they also experience minor and major complications 3 times as often as their elective surgery counterparts. 9 The traditional model of care for EGS patients was an "oncall" system.…”

mentioning

confidence: 99%

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

Vergis¹,

Metcalfe²,

Stogryn³

et al. 2019

cjs

View full text Add to dashboard Cite

Background: Dedicated emergency general surgery (EGS) service models were developed to improve efficiency of care and patient outcomes. The degree to which the EGS model delivers these benefits is debated. We performed a systematic review of the literature to identify whether the EGS service model is associated with greater efficiency and improved outcomes compared to the traditional model. Methods:We searched MEDLINE, Embase, Scopus and Web of Science (Core Collection) databases from their earliest date of coverage through March 2017. Pri mary outcomes for efficiency of care were surgical response time, time to operation and total length of stay in hospital. The primary outcome for evaluating patient out comes was total complication rate. Results:The EGS service model generally improved efficiency of care and patient outcomes, but the outcome variables reported in the literature varied.Conclusion: Development of standardized metrics and comprehensive EGS data bases would support quality control and performance improvement in EGS systems.

show abstract

Risk factors for postoperative mortality and morbidities in emergency surgeries

Cited by 38 publications

References 29 publications

Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

Association of Model for End-Stage Liver Disease Score With Mortality in Emergency General Surgery Patients

Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

Contact Info

Product

Resources

About