The association between ICU admission and emergency hospital readmission following emergency general surgery

Gillies, Michael; Ghaffar, Sadia; Haddow, Catriona; Smyth, Lorraine; Walsh, Timothy; Pearse, Rupert M; Lone, Nazir

doi:10.1177/1751143719843416

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…The main reasons for short-term readmissions were wound complications and complications related to the gastrointestinal tract, such as prolonged paralysis, high-output stoma, and abdominal pain directly related to the surgery. This is in agreement with previous research, which reported the main reasons for 30-day readmission were surgical complications such as gastrointestinal or wound complications [ 1 , 2 ]. Furthermore, we found that stomal placement during the index procedure is an independent risk factor for short-term emergency readmission.…”

Section: Discussionsupporting

confidence: 93%

“…The main reasons for short-term readmission after abdominal surgery are wound infections and gastrointestinal complaints [ 1 , 2 , 12 ], and postoperative complications before discharge seem to increase the risk of readmission [ 13 ]. One study found that readmissions were mainly due to complications that occurred after discharge rather than an exacerbation of in-hospital complications [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

í Soylu,

Kokotovic,

Gögenur

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Major emergency abdominal surgery is associated with severe in-hospital complications and loss of performance. After discharge, a substantial fraction of patients are readmitted emergently; however, limited knowledge exists of the long-term consequences. The aim of this study was to examine the risks and causes of short-term (30-day) and long-term (180-day) readmission among patients undergoing major emergency abdominal surgery. Methods This study included 504 patients who underwent major emergency abdominal surgery at the Zealand University Hospital between March 1, 2017, and February 28, 2019. The population was followed from 0 to 180 days after discharge, and detailed readmission information was registered. A Cox proportional hazards model was used to examine the independent risk factors for readmission within 30 and 180 days. Results From 0 to 30 days after discharge, 161 (31.9%) patients were readmitted emergently, accumulating to 241 (47.8%) patients within 180 days after discharge. The main reasons for short-term readmission were related to the gastrointestinal tract and surgical wounds, whereas long-term readmissions were due to infections, cardiovascular complications, and abdominal pain. Stomal placement was an independent risk factor for short-term readmission, whereas an ASA score of 3 was a risk factor for both short-term and long-term readmission. Conclusion Close to 50% of all patients who underwent major emergency abdominal surgery had one or more emergency readmission within 180 days of discharge, and these data points towards the risk factors involved.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

í Soylu,

Kokotovic,

Gögenur

et al. 2023

Eur J Trauma Emerg Surg

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“…As it would have been difficult to predict these events from preoperative comorbidities or surgical procedures in each patient, postoperative patient evaluation according to certain evaluation criteria such as Clavien-Dindo classification or modified one in the ward within 3 postoperative cardiovascular complications. Early detection of postoperative complications would be crucial because unplanned ICU admission from the ward has been also shown associated with increased emergency hospital readmission after surgery [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

et al. 2022

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Background Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge. Methods Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay. Results Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively). Conclusions The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU.

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“…A longer hospital length of stay, a higher cost, and an increase in long-term mortality are all linked to hospital readmission after surgery. 7 There are constraints to the use of 30-day readmission rates as a quality indicator for hospital care. Although there are some aspects that cannot be changed, there are still some factors that can influence patient readmission and hospital use.…”

Section: Discussionmentioning

confidence: 99%

Readmission rates and risk factors associated with emergency surgeries

Siddiqui

Albawardi²,

Alqahtani

et al. 2022

Int J Community Med Public Health

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Emergency surgery requires complex and diversified skills and talents to execute procedures from several fields of surgery within 24 hours. The prevalence of emergency surgery is also increasing in recent times and the cohort for emergency general surgery is particularly at risk for readmission. Readmission is considered as one of the predictors of the quality of healthcare. Readmission following emergency surgery is frequent and varies greatly based on patient characteristics and diagnostic types. Readmission is associated with the significant morbidity and mortality, also adds to the increased hospital burden. Various risk factors account for the readmission. The purpose of this research is to review the available information about the readmission rates and risk factors associated with emergency surgeries. About half of patients undergoing emergency surgeries will experience a postoperative complication, and postoperative complications have a strong correlation with hospital readmission. Postoperative complications and readmission have a significant negative influence on patient quality of life and healthcare resources. Different studies have reported an increased prevalence of readmissions after emergency surgeries. Surgical site infection, increased length of hospital stays, readmission at the non-index hospital, comorbidities are some of the commonly reported risk factors of readmission. Establishment and implementation of the preventive strategies for the control of risk factors of readmission can help in reducing the readmission burden.

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The association between ICU admission and emergency hospital readmission following emergency general surgery

Cited by 5 publications

References 26 publications

Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

Short and long-term readmission after major emergency abdominal surgery: a prospective Danish study

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

Readmission rates and risk factors associated with emergency surgeries

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