National estimates of predictors of outcomes for emergency general surgery

Adil Aijaz Shah, Adil Hussain Haider, Cheryl K. Zogg, Diane Alyse Schwartz, Elliott R. Haut, Syed Nabeel Zafar, Eric B. Schneider, Catherine G. Velopulos, Shahid Shafi, Hasnain Zafar, David T. Efron

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Identifying predictors of mortality and surgical complications has led to outcome improvements for a variety of surgical conditions. However, similar work has yet to be done for factors affecting outcomes of emergency general surgery (EGS). The objective of this study was to determine the predictors of in-hospital complications and mortality among EGS patients. METHODS The Nationwide Inpatient Sample (2003-2011) was queried for patients with conditions encompassing EGS as determined by the American Association for Surgery of Trauma, categorizing them into predefined EGS groups using DRG International Classification of Diseases - 9th Rev. - Clinical Modification codes. Primary outcomes considered included incidence of a major complication (pneumonia, pulmonary emboli, urinary tract infections, myocardial infarctions, sepsis, or septic shock) and in-hospital mortality. Separate multivariate logistic regression analyses for complications and mortality were performed to identify risk factors of either outcome from the following domains: patient demographics (age, sex, insurance type, race, and income quartile), comorbidities, and hospital characteristics (location, teaching status, and bed size). RESULTS This study included 6,712,151 discharge records, weighted to represent 32,910,446 visits for EGS conditions. Mean age was 58.50 (19.74) years; slightly more than half (54.66%) were female. Uninsured patients were more likely to die (odds ratio,1.25; 95% confidence interval, 1.20-1.30), whereas patients in the highest income quartile had the least likelihood of mortality (odds ratio, 0.86; 95% confidence interval, 0.84-0.87). Old age was an independent predictor of mortality for all EGS subdiagnoses. The overall mortality rate was 1.76%; the overall complication rate was 10.03%. Of the patients who died, 62% experienced at least one major complication. Patients requiring resuscitation had the highest likelihood of mortality followed by patients with vascular disease and hepatic disease. CONCLUSION Death patterns of EGS patients were discerned using an administrative data set. Understanding patterns of mortality and complications derived from studies such as this could improve hospital benchmarking for EGS, akin to trauma surgery's previous success. LEVEL OF EVIDENCE Prognostic and epidemiologic study, level III.

Original languageEnglish (US)
Pages (from-to)482-491
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number3
DOIs
StatePublished - Mar 6 2015

Keywords

  • Acute care surgery
  • complications
  • emergency general surgery
  • mortality
  • quality of care

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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