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Degu S, Kejela S, Zeleke HT. Perioperative mortality of emergency and elective surgical patients in a low-income country: a single institution experience. Perioper Med (Lond) 2023; 12:49. [PMID: 37715264 PMCID: PMC10504717 DOI: 10.1186/s13741-023-00341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The perioperative mortality rate is an indicator of access to safe anesthesia and surgery. Studies showed higher perioperative mortality rates among low- and middle-income countries. But the specific causes and factors contributing to perioperative death have not been adequately studied in the Ethiopian context. METHODS This is a retrospective institutional study of the largest academic medical center in Ethiopia. Data of all patients who were admitted to surgical wards or intensive care and underwent surgical interventions were evaluated for perioperative mortality rate determination. All mortality cases were then evaluated in depth. RESULTS Of the 3295 patients evaluated, a total of 148 patients (4.5%) died within 30 days of surgery. By the 7th postoperative day, 69.5% of the perioperative mortality had already occurred. Septic shock contributed to 54.2% of deaths. Emergency surgery patients had more than a twofold higher mortality rate than elective surgery patients (p value < 0.001) and had a 2.6-fold higher rate of dying within 7 days of surgery (p value of 0.02). Patients with ASA performance status of 3 or more had a 1.7-fold higher rate of death within 72 h of surgery (p value of 0.015). CONCLUSION More than two thirds of patients died within 7 postoperative days. More emergency patients died than elective counterparts, and emergency cases had a higher rate of dying within 7 days of surgery. Poor ASA performance score was associated with earlier postoperative death. Further prospective multi-institutional studies are warranted to elucidate the factors that contribute to higher postoperative mortality in low-income country patients.
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Affiliation(s)
- Samrawit Degu
- Department of Surgery, Lancet Biherawi General Hospital, Addis Ababa, Ethiopia
| | - Segni Kejela
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Geier TJ, Simske N, Melin S, Trevino C, Murphy P, Schroeder ME, Brandolino A, deRoon-Cassini T, Schramm AT. Psychiatric comorbidity in emergency general surgery patients: a prospective observational study. Trauma Surg Acute Care Open 2023; 8:e001117. [PMID: 37622160 PMCID: PMC10445363 DOI: 10.1136/tsaco-2023-001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives Annually, approximately 27 million individuals in the United States are admitted to hospitals for emergency general surgery (EGS). Approximately 50% develop postoperative complications and 22% require unplanned readmission within 90 days, highlighting a need to understand factors impacting well-being and recovery. Psychiatric comorbidity can impact medical treatment adherence, cost, and premature mortality risk. Despite the severity of illness in EGS, there is limited research on psychiatric comorbidity in EGS patients. Thus, the purpose of the current study was to characterize EGS patient mental health and to assess its relationship with pain, social support, and healthcare utilization (ie, length of stay, readmission). Methods Adult EGS patients were screened for participation during hospitalization. Inclusion criteria included: (1) 18 years or older, (2) communicate fluently in English, and (3) assessed within 7 days of admission. Participants (n=95) completed assessment, which included a structured clinical diagnostic interview. Record review captured medical variables, including length of stay, discharge disposition, narcotic prescription, and 90-day readmission rates. Results Ninety-five patients completed the assessment, and 31.6% met criteria for at least one current psychiatric diagnosis; 21.3% with a major depressive episode, 9.6% with a substance use disorder, and 7.5% with post-traumatic stress disorder (PTSD). Lower perceived social support and greater pain severity and interference were significantly related to more severe depression and anxiety. Depression was associated with longer length of stay, and those with PTSD were more likely to be re-admitted. Conclusion The EGS patient sample exhibited psychiatric disorder rates greater than the general public, particularly regarding depression and anxiety. Screening protocols and incorporation of psychological and social interventions may assist in recovery following EGS. Level of evidence Level II, prognostic.
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Affiliation(s)
- Timothy J Geier
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natasha Simske
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah Melin
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colleen Trevino
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Patrick Murphy
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Amber Brandolino
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Terri deRoon-Cassini
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew T Schramm
- Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Flores‐Mendoza H, Chandran AR, Hernandez‐Nieto C, Murji A, Allen L, Windrim RC, Kingdom JC, Hobson SR. Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean‐hysterectomy within a multidisciplinary care team. Int J Gynaecol Obstet 2022; 159:404-411. [DOI: 10.1002/ijgo.14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Homero Flores‐Mendoza
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Anjana Ravi Chandran
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Carlos Hernandez‐Nieto
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Ali Murji
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Lisa Allen
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Rory C. Windrim
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - John C. Kingdom
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
| | - Sebastian R. Hobson
- Department of Obstetrics & Gynaecology University of Toronto & Mount Sinai Hospital Toronto ON Canada
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Geense WW, Zegers M, Peters MAA, Ewalds E, Simons KS, Vermeulen H, van der Hoeven JG, van den Boogaard M. New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study. Am J Respir Crit Care Med 2021; 203:1512-1521. [PMID: 33526001 DOI: 10.1164/rccm.202009-3381oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: Comprehensive studies addressing the incidence of physical, mental, and cognitive problems after ICU admission are lacking. With an increasing number of ICU survivors, an improved understanding of post-ICU problems is necessary. Objectives: To determine the occurrence and cooccurrence of new physical, mental, and cognitive problems among ICU survivors 1 year after ICU admission, their impact on daily functioning, and risk factors associated with 1-year outcomes. Methods: Prospective multicenter cohort study, including ICU patients ⩾16 years of age, admitted for ⩾12 hours between July 2016 and June 2019. Patients, or proxies, rated their health status before and 1 year after ICU admission using questionnaires. Measurements and Main Results: Validated questionnaires were used to measure frailty, fatigue, new physical symptoms, anxiety and depression, post-traumatic stress disorder, cognitive impairment, and quality of life. Of the 4,793 patients included, 2,345 completed the questionnaires both before and 1 year after ICU admission. New physical, mental, and/or cognitive problems 1 year after ICU admission were experienced by 58% of the medical patients, 64% of the urgent surgical patients, and 43% of the elective surgical patients. Urgent surgical patients experienced a significant deterioration in their physical and mental functioning, whereas elective surgical patients experienced a significant improvement. Medical patients experienced an increase in symptoms of depression. A significant decline in cognitive functioning was experienced by all types of patients. Pre-ICU health status was strongly associated with post-ICU health problems. Conclusions: Overall, 50% of ICU survivors suffer from new physical, mental, and/or cognitive problems. An improved insight into the specific health problems of ICU survivors would enable more personalized post-ICU care.
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Affiliation(s)
| | | | - Marco A A Peters
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Esther Ewalds
- Department of Intensive Care Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands; and
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Gao S, Wang Y, Yang L, Wang Z, Huang W. Characteristics and clinical subtypes of cancer patients in the intensive care unit: a retrospective observational study for two large databases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:13. [PMID: 33553306 PMCID: PMC7859733 DOI: 10.21037/atm-20-4634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Previous studies have reported very different mortality rates among cancer patients in the intensive care unit (ICU), implying different clinical subtypes. We aimed to reveal the clinical subtypes and demonstrate the importance of segregating the patients in clinical research, and to report the ICD-level mortality of cancer patients in the ICU. Methods Two ICU databases (MIMIC-III and eICU) were utilized to identify cancer patients. Mortality based on ICD-level diagnoses were calculated, and K-means clustering was used to identify different clinical subtypes in the MIMIC database. Clinical characteristics and outcomes were compared among subtypes, and the calibration of SAPS II and APACHE IV among different subtypes was evaluated. Results In total, 6,505 (13.8%) cancer patients of the MIMIC database and 7,351 (4.9%) ones in eICU database, were enrolled in the study. Metastasis involving pleura, metastasis involving the liver, and acute myeloid leukemia were in the top 5 diagnoses with the highest mortality in both databases. Clinical subtypes identified by K-means clustering were closely associated with admission type (elective or emergency) and clinical service provider (surgical or medical). In a four-cluster pattern, nearly all patients in the first cluster were elective admissions (99.1%), whereas in the rest of the clusters, most were emergency admissions (93.7%). Most surgical patients were in the 1+2 clusters (92.0%) and most medical patients were in the 3+4 clusters (93.5%). Most characteristics and outcomes as well as the calibration of SAPS II and APACHE IV scoring systems were significantly different among clinical subtypes. Conclusions Different clinical subtypes can be well identified by admission type and clinical service provider among ICU patients with cancer. Caution should be exercised when considering these patients as a whole population both in clinical practice and research. Moreover, APACHE IV has better calibration than SAPS II for cancer patients at low risk of mortality in the ICU.
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Affiliation(s)
- Shaowei Gao
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Yang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongxing Wang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenqi Huang
- Department of Anesthesia, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Weissman C, Scemama J, Weiss YG. The ratio of PACU length-of-stay to surgical duration: Practical observations. Acta Anaesthesiol Scand 2019; 63:1143-1151. [PMID: 31264209 DOI: 10.1111/aas.13421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Operating room (OR) and post-anesthesia care unit (PACU) activity are closely linked since the number, type, and sequence of surgeries influence subsequent PACU activity. We aimed to explore the relationship between duration-of-surgery (DOS) and PACU length-of-stay (LOS), the PACU-LOS:DOS ratio, since it is among the determinants of the number of PACU beds and nurse staffing required to insure efficient egress of patients from the OR. METHODS PACU-LOS:DOS ratio was examined using retrospective data from a tertiary medical center's surgical information system (Phase 1) and prospectively collected data from a convenience sample of post-operative patients (Phase 2). RESULTS Phase 1 included 17 047 patients, the majority (73%) with PACU-LOS:DOS ratios >1.0, indicating PACU-LOS longer than DOS. Median PACU-LOS was 117 minutes, median DOS was 80 minutes, and median PACU-LOS/DOS ratio was 1.5. PACU-LOS showed greater variability than DOS because of extended PACU stays. Phase 2 (n = 2054) confirmed Phase 1 results (median PACU-LOS/DOS ratio - 1.8). In both phases at a DOS of >130 minutes PACU-LOS/DOS ratio became <1.0. In 24% of Phase 2 patients PACU-LOS was prolonged because of administrative issues. Post-operative, more than pre- and intra-operative, measurements influenced PACU-LOS. CONCLUSIONS The PACU-LOS/DOS ratio proved useful for demonstrating interactions between 2 central components of the surgical system. The many patients with PACU-LOS:DOS ratios >1.0 provides objective evidence for the number of PACU beds exceeding the number of ORs.
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Affiliation(s)
- Charles Weissman
- Department of Anesthesiology and Critical Care Medicine and Hospital Administration Hadassah – Hebrew University Medical Center Jerusalem Israel
- Hebrew University – Hadassah School of Medicine Jerusalem Israel
| | - Jeremy Scemama
- Department of Anesthesiology and Critical Care Medicine and Hospital Administration Hadassah – Hebrew University Medical Center Jerusalem Israel
- Hebrew University – Hadassah School of Medicine Jerusalem Israel
| | - Yoram G. Weiss
- Department of Anesthesiology and Critical Care Medicine and Hospital Administration Hadassah – Hebrew University Medical Center Jerusalem Israel
- Hebrew University – Hadassah School of Medicine Jerusalem Israel
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Reis P, Lopes AI, Leite D, Moreira J, Mendes L, Ferraz S, Amaral T, Abelha F. Predicting mortality in patients admitted to the intensive care unit after open vascular surgery. Surg Today 2019; 49:836-842. [DOI: 10.1007/s00595-019-01805-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/23/2019] [Indexed: 01/22/2023]
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8
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Reis PV, Sousa G, Lopes AM, Costa AV, Santos A, Abelha FJ. Severity of disease scoring systems and mortality after non-cardiac surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29628154 PMCID: PMC9391813 DOI: 10.1016/j.bjane.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. Methods Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann–Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). Results 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR = 1.24); emergent surgery (OR = 4.10), serum sodium (OR = 1.06) and FiO2 at admission (OR = 14.31). Serum bicarbonate at admission (OR = 0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR = 1.02), APACHE II (OR = 1.09), emergency surgery (OR = 1.82), high-risk surgery (OR = 1.61), FiO2 at admission (OR = 1.02), postoperative acute renal failure (OR = 1.96), heart rate (OR = 1.01) and serum sodium (OR = 1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. Conclusion Some factors influenced both surgical intensive care unit and hospital mortality.
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Affiliation(s)
- Pedro Videira Reis
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Gabriela Sousa
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal
| | | | - Ana Vera Costa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Alice Santos
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal
| | - Fernando José Abelha
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Porto, Portugal.
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9
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Reis PV, Sousa G, Lopes AM, Costa AV, Santos A, Abelha FJ. [Severity of disease scoring systems and mortality after non-cardiac surgery]. Rev Bras Anestesiol 2018; 68:244-253. [PMID: 29628154 DOI: 10.1016/j.bjan.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/22/2017] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Mortality after surgery is frequent and severity of disease scoring systems are used for prediction. Our aim was to evaluate predictors for mortality after non-cardiac surgery. METHODS Adult patients admitted at our surgical intensive care unit between January 2006 and July 2013 was included. Univariate analysis was carried using Mann-Whitney, Chi-square or Fisher's exact test. Logistic regression was performed to assess independent factors with calculation of odds ratio and 95% confidence interval (95% CI). RESULTS 4398 patients were included. Mortality was 1.4% in surgical intensive care unit and 7.4% during hospital stay. Independent predictors of mortality in surgical intensive care unit were APACHE II (OR=1.24); emergent surgery (OR=4.10), serum sodium (OR=1.06) and FiO2 at admission (OR=14.31). Serum bicarbonate at admission (OR=0.89) was considered a protective factor. Independent predictors of hospital mortality were age (OR=1.02), APACHE II (OR=1.09), emergency surgery (OR=1.82), high-risk surgery (OR=1.61), FiO2 at admission (OR=1.02), postoperative acute renal failure (OR=1.96), heart rate (OR=1.01) and serum sodium (OR=1.04). Dying patients had higher scores in severity of disease scoring systems and longer surgical intensive care unit stay. CONCLUSION Some factors influenced both surgical intensive care unit and hospital mortality.
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Affiliation(s)
- Pedro Videira Reis
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Gabriela Sousa
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal
| | | | - Ana Vera Costa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Alice Santos
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal
| | - Fernando José Abelha
- Hospital de São João, Serviço de Anestesiologia, Porto, Portugal; Universidade do Porto, Faculdade de Medicina, Porto, Portugal.
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Becher RD, Davis KA, Rotondo MF, Coimbra R. Ongoing Evolution of Emergency General Surgery as a Surgical Subspecialty. J Am Coll Surg 2017; 226:194-200. [PMID: 29111417 DOI: 10.1016/j.jamcollsurg.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Robert D Becher
- Department of Surgery, Section of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT
| | - Kimberly A Davis
- Department of Surgery, Section of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT
| | - Michael F Rotondo
- Department of Surgery, the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, CA.
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Trevino CM, Katchko KM, Verhaalen AL, Bruce ML, Webb TP. Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies. World J Surg 2016; 40:856-62. [PMID: 26470696 DOI: 10.1007/s00268-015-3266-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fast-track protocols (FTPs) are used to decrease length of stay (LOS) and hospital costs for elective outpatient procedures. Few institutions have implemented FTP for urgent procedures such as laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA). STUDY DESIGN This is a retrospective single-institution cohort study including all patients undergoing urgent LC or LA between July 1, 2010 and May 1, 2013. Exclusion criteria included conversion to open procedure, perforated appendicitis, or procedure related to intra-abdominal injury. Analysis included a comparison of the three study groups: (1) before (PRE) and after (POST) implementation of the fast-track protocol (FTP), (2) fast-track cohort (FT) and non-fast-track cohort (NFT), and (3) those completing the fast-track pathway (FT-C) and those who began but failed to complete the pathway (FT-F). RESULTS There were significant reductions in LOS between all study groups compared: between PRE (n = 256) and POST (n = 472) cohorts by half a day (2.0 vs. 1.5 days, p < 0.02); between FT and NFT (0.68 vs. 1.82 days, p < 0.01); and FT-C and FT-F (0.49 vs. 1.05 days, p < 0.01). Total hospital charges were significantly reduced in FT compared with NFT ($22,347 vs. $30,868, p < 0.01) with an average savings of $8521. Total hospital charges were decreased in the FT-C compared with FT-F cohorts ($21,971 vs. $22,939, p = 0.3) with an average savings of $968. Readmissions, complications, and satisfaction were similar for all comparison groups. CONCLUSIONS FTPs for urgent appendectomies and cholecystectomies can significantly reduce hospital costs by reducing LOS without compromising patient outcomes.
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Affiliation(s)
- Colleen M Trevino
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
| | - Karina M Katchko
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
| | - Amy L Verhaalen
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
| | - Marie L Bruce
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
| | - Travis P Webb
- Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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12
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Küpper S, Karvellas CJ, Khadaroo RG, Widder SL. Increased health services use by severely obese patients undergoing emergency surgery: a retrospective cohort study. Can J Surg 2015; 58:41-7. [PMID: 25427335 DOI: 10.1503/cjs.003914] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to assess perioperative outcomes in obese patients undergoing emergency surgery. METHODS We retrospectively reviewed the charts of all adult (> 17 yr) patients admitted to the acute care emergency surgery service at the University of Alberta Hospital between January 2009 and December 2011 who had a body mass index (BMI) of 35 or higher. Patients were divided into subgroups for analysis based on "severe" (BMI 35-39.9) and "morbid" obesity (BMI ≥ 40). Multivariate logistic regression was performed to identify predictors of in-hospital mortality after controlling for confounding factors. RESULTS Data on 111 patients (55% women, median BMI 39) were included in the final analysis. Intensive care unit (ICU) support was required for 40% of patients. Postoperative complications occurred in 42% of patients, and 31% required reoperation. Overall in-hospital mortality was 17%. Morbidly obese patients had increased rates of reoperation (40% v. 23%, p = 0.05) and increased lengths of stay compared with severely obese patients (14.5 v. 6.0 d, p = 0.09). Age (odds ratio [OR] 1.08 per increment) and preoperative ICU stay (OR 12) were significantly associated with in-hospital mortality after controlling for confounding, but BMI was not. CONCLUSION Obese patients requiring emergency surgery represent a complex patient population at high risk for perioperative morbidity and mortality. Greater resources are required for their care, including ICU support, repeat surgery and prolonged ICU stay. Future studies could help identify predictors of reoperation and strategies to optimize nutrition, rehabilitation and resource allocation.
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Affiliation(s)
- Suzana Küpper
- The Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, Alta
| | - Constantine J Karvellas
- The Division of Gastroenterology, Department of Medicine and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta
| | - Rachel G Khadaroo
- The Division of General Surgery, Department of Surgery, and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta
| | - Sandy L Widder
- The Division of General Surgery, Department of Surgery, and the Division of Critical Care Medicine, University of Alberta, Edmonton, Alta
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13
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Evidence-based clinical practice manual: Postoperative complications management☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543010-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Manual de práctica clínica basado en la evidencia: manejo de complicaciones posquirúrgicas. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rca.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Calvache JA, Guzmán ÉL, Buitrago LMG, Torres CG, Torres M, Buitrago G, Duarte HG. Evidence-based clinical practice manual: Postoperative complications management. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yılmaz KB, Akıncı M, Şeker D, Güller M, Güneri G, Kulaçoğlu H. Factors affecting the safety of drains and catheters in surgical patients. ULUSAL CERRAHI DERGISI 2014; 30:90-2. [PMID: 25931902 DOI: 10.5152/ucd.2014.2564] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/02/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Drains and catheters are used for both prophylactic and therapeutic reasons in clinical practice. This study aimed to investigate the factors that affect safety of drains, catheters, nasogastric tube and central venous line in patients who underwent surgery. MATERIAL AND METHODS Two hundred and four consecutive patients who were operated at the general surgery clinics under general anesthesia were included in the study. Factors that affect the safety of drains and catheter were followed and recorded prospectively. RESULTS During follow-up period, 12 (5.8%) patients have experienced problems regarding safety of drains/catheters. The mean age of patients who were followed-up in terms of security problems was 63.1 (39-86) years. Eight (66.7%) patients had been operated emergently, and four (33.3%) patients electively. Three (25%) patients had psychiatric/neurological co-morbidities and 3 (25%) patients were confused due to anesthesia/intensive care unit treatment when the drain safety was broken. Eight (66.7%) patients withdrew the drains or catheters by themselves, in 2 (16.7%) patients the drains spontaneously came out and in 2 (16.7%) patients the wrong drain was withdrawn. One patient had dementia, one patient had Alzheimer's disease and one patient was being followed-up with a diagnosis of schizophrenia. In three (25%) patients the abdominal drain, in four (33.3%) patients nasogastric tube, in one (8.3%) patient intubation tube, in one (8.3%) patient central venous catheter, and in three (25%) patients multiple drains were removed. CONCLUSION The inaccurate use of drains or re-intervention for an unintentionally removed drain causes problems regarding patient safety. Close monitoring of surgical patients in terms of security, and submission of additional measures for patients with confusion and neurological/psychiatric disorders are of great importance.
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Affiliation(s)
- Kerim Bora Yılmaz
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Melih Akıncı
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Duray Şeker
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Müjdat Güller
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Gürkan Güneri
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
| | - Hakan Kulaçoğlu
- Clinic of General Surgery, Dışkapı Teaching and Training Hospital, Ankara, Turkey
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Stapled versus hand-sewn anastomoses in emergency general surgery. J Trauma Acute Care Surg 2013; 74:1187-92; discussion 1192-4. [DOI: 10.1097/ta.0b013e31828cc9c4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Stapled versus hand-sewn anastomoses in emergency general surgery: A retrospective review of outcomes in a unique patient population. J Trauma Acute Care Surg 2013. [DOI: 10.1097/01586154-201305000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A research agenda for emergency general surgery: health policy and basic science. J Trauma Acute Care Surg 2013; 74:322-8. [PMID: 23271106 DOI: 10.1097/ta.0b013e31827d0fe3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Becher RD, Meredith JW, Chang MC, Hoth JJ, Beard HR, Miller PR. Creation and implementation of an emergency general surgery registry modeled after the National Trauma Data Bank. J Am Coll Surg 2011; 214:156-63. [PMID: 22153352 DOI: 10.1016/j.jamcollsurg.2011.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 10/04/2011] [Accepted: 11/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND As emergency general surgery (EGS) evolves, an EGS patient-tracking database (EGS registry [EGSR]) similar to the National Trauma Data Bank (NTDB) will be essential to study outcomes and improve care. The goal of this study was to establish diagnostic ICD-9 codes to define EGS patients. The hypothesis was that creating standardized ICD-9-based inclusion criteria would facilitate patient identification for an EGSR and aid in its ongoing development. STUDY DESIGN We conducted a retrospective review of EGS admissions over a 9-month period to define ICD-9 diagnostic codes of patients admitted to our EGS service. Subsequently, prospective data were collected into the EGSR by testing ICD-9-based inclusion criteria over 1 month. Patient, hospital, and severity scoring variables, as well as quality assurance information, were identified. RESULTS We identified 959 admissions to the EGS service over 9 months with 306 ICD-9 diagnosis codes that define EGS patients; the prospective population of the EGSR confirmed feasibility of ICD-9-based inclusion criteria. The EGSR captures 107 data points and 33 comorbidities per patient over 11 categories, akin to the 10 NTDB categories. CONCLUSIONS Following the model of the NTDB, we have successfully completed creation and initial implementation of an EGSR by using ICD-9-based inclusion criteria. Our comprehensive EGSR creates a prospective data-collection modality to capture and define EGS patients. A uniform patient-tracking EGSR, akin to the NTDB, will advance the science of acute care surgery, improve EGS patient outcomes, and facilitate multi-institutional collaboration.
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Affiliation(s)
- Robert D Becher
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Eichenberger AS, Haller G, Cheseaux N, Lechappe V, Garnerin P, Walder B. A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission. Eur J Anaesthesiol 2011; 28:859-66. [DOI: 10.1097/eja.0b013e328347dff5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Becher RD, Hoth JJ, Miller PR, Mowery NT, Chang MC, Meredith JW. A Critical Assessment of Outcomes in Emergency versus Nonemergency General Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Database. Am Surg 2011. [DOI: 10.1177/000313481107700738] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Emergent operations are thought to carry higher morbidity and mortality than nonemergent cases. However, there is a lack of specific outcomes data for emergent general surgery procedures. The objective of our study was to assess and quantify postoperative morbidity and mortality for emergency versus nonemergency general surgery operations. All general surgery inpatients were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 database. Preoperative, intraoperative, and postoperative clinical metrics and occurrences were assessed. A total of 25,770 emergent and 98,867 nonemergent cases were identified. Postoperative morbidity was significantly worse in the emergent group, including ventilation more than 48 hours, bleeding requiring transfusion, deep vein thrombosis, renal failure, and need for reoperation. Overall, emergent cases had significantly more postoperative complications (22.8% vs 14.2%) and higher mortality rates (6.5% vs 1.4%). General surgery patients who undergo emergent operations have significantly poorer outcomes when compared with nonemergent patients; our analysis has quantified these differences. Emergent patients seem to manifest unique clinical, pathophysiologic, and inflammatory responses to their surgical disease. This data suggests that there is a need for improvement in both methods and systems of care for the emergent population.
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Affiliation(s)
- Robert D. Becher
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - J. Jason Hoth
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Preston R. Miller
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Nathan T. Mowery
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael C. Chang
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - J. Wayne Meredith
- Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Abstract
BACKGROUND AND OBJECTIVE A Pre-operative Therapeutic Intensity Score (P-TIS) was developed to quantify intensity of pre-operative care. Its association with post-operative ICU admission was explored. METHODS P-TIS assigns 1-4 points to therapeutic interventions and diagnostic procedures based on care intensity. P-TIS was evaluated using elective (n = 716) and emergency (n = 289) surgery patients entering the post-anaesthesia care unit (PACU) or directly admitted to ICU. RESULTS P-TIS has chronic (interventions >48 h before surgery, e.g. chronic dialysis therapy: 3 points, oral antibiotics: 1 point) and acute (interventions within 48 h of surgery, e.g. intra-aortic balloon: 4 points, urinary catheter insertion: 1 point) components. Acute P-TIS provided quantitative information, not provided by other methods, about care intensity immediately before surgery. High acute P-TIS were observed in elective patients with high chronic P-TIS and ASA classifications (3 and 4) and emergency surgery and trauma. The higher acute P-TIS, the more likely emergency patients are to receive post-operative ICU rather than intermediate or routine floor care (odds ratio 1.18, P < 0.001). Adding surgical complexity improved acute P-TIS's ability to predict post-operative ICU care in elective patients. CONCLUSION P-TIS quantifies the intensity of chronic and acute pre-operative care. Acute P-TIS predicted receipt of post-operative ICU care, especially in emergency surgery.
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