Morbidity, mortality, and risk factors of emergency colorectal surgery among older patients in the Acute Care Surgery service: A retrospective study

Abstract Background: Acute Care Surgery (ACS) is a rapid response system in emergency surgical conditions. Older patients have numerous factors associated with high mortality and morbidity in emergency colorectal surgery. We aimed to identify potentially preventable risk factors, to improve older patients’ outcomes.Methods: A retrospective review of patients over 60 years old undergoing emergency colorectal surgery in the ACS service from 1 August 2017 through 30 November 2019.Results: Data of 92 patients were analyzed, average age 72.41 years. The most common diagnosis was colorectal cancer (76, 83.52%) with locations on the left (37, 41.51%), right (35,39.33%), and rectum (17, 19.10%). Clinical presentations were obstruction without perforation (61, 67.03%), perforation (25, 27.17%), and ischemia (2, 2.17%). Overall mortality was 6.52%. Cause of death included septic shock (3, 50%); respiratory failure (3, 50%); and pulmonary embolism (1, 16.67%). Morbidity from surgical and medical complications were 41.30% and 26.08%, respectively. For all causes, operations included resection with primary anastomosis (62, 71.26%); Hartman procedure (11, 12.64%); loop colostomy (12, 13.79%); and percutaneous drainage with antibiotics (2, 2.3%). Average operative time 159.86 minutes. In emergency colorectal surgery, preexisting heart disease, clinical perforation, and ventilator dependency increased risk of death 7.6-, 16.5-, and 0.08-fold, respectively.Conclusion: Preexisting heart disease and clinical perforation were unmodifiable risk factors for mortality among older patients undergoing emergency colorectal surgery; ventilator dependency is potentially modifiable with advanced surgical critical care. Early, rapid, protocol-driven processes might help reduce mortality in patients with clinical presentation of perforation.

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Morbidity, mortality, and risk factors of emergency colorectal surgery among older patients in the Acute Care Surgery service.

10.21203/rs.3.rs-26881/v1 ◽

2020 ◽

Author(s):

Chonlada Krutsri ◽

Preeda Sumpritpradit ◽

Pongsasit Singhatas ◽

Tharin Thampongsa ◽

Samart Phuwapraisirisan ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Colorectal Surgery ◽

Acute Care ◽

Older Patients ◽

Acute Care Surgery ◽

Risk Of Death ◽

Common Diagnosis ◽

Care Surgery ◽

Emergency Colorectal Surgery

Abstract Background: Acute Care Surgery (ACS) is a rapid response system in emergency surgical conditions. Older patients have numerous factors associated with high mortality and morbidity in emergency colorectal surgery. We aimed to identify potentially preventable risk factors, to improve older patients’ outcomes.Methods: A retrospective review of patients over 60 years old undergoing emergency colorectal surgery in the ACS service from 1 August 2017 through 30 November 2019.Results: Data of 92 patients were analyzed, average age 72.41 years. The most common diagnosis was colorectal cancer (76, 83.52%) with locations on the left (37, 41.51%), right (35,39.33%), and rectum (17, 19.10%). Clinical presentations were obstruction without perforation (61, 67.03%), perforation (25, 27.17%), and ischemia (2, 2.17%). Overall mortality was 6.52%. Cause of death included septic shock (3, 50%); respiratory failure (3, 50%); and pulmonary embolism (1, 16.67%). Morbidity from surgical and medical complications were 41.30% and 26.08%, respectively. For all causes, operations included resection with primary anastomosis (62, 71.26%); Hartman procedure (11, 12.64%); loop colostomy (12, 13.79%); and percutaneous drainage with antibiotics (2, 2.3%). Average operative time 159.86 minutes. In emergency colorectal surgery, preexisting heart disease, clinical perforation, and ventilator dependency increased risk of death 7.6-, 16.5-, and 0.08-fold, respectively. Conclusion: Preexisting heart disease and clinical perforation were unmodifiable risk factors for mortality among older patients undergoing emergency colorectal surgery; ventilator dependency is potentially modifiable with advanced surgical critical care. Early, rapid, protocol-driven processes might help reduce mortality in patients with clinical presentation of perforation.

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Laparoscopy at all costs? Not now during COVID-19 outbreak and not for acute care surgery and emergency colorectal surgery: A practical algorithm from a hub tertiary teaching hospital in Northern Lombardy, Italy

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002727 ◽

2020 ◽

Vol 88 (6) ◽

pp. 715-718 ◽

Cited By ~ 23

Author(s):

Salomone Di Saverio ◽

Mansoor Khan ◽

Francesco Pata ◽

Giuseppe Ietto ◽

Belinda De Simone ◽

...

Keyword(s):

Colorectal Surgery ◽

Acute Care ◽

Teaching Hospital ◽

Acute Care Surgery ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

Practical Algorithm ◽

Care Surgery ◽

Emergency Colorectal Surgery

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Laparoscopic cholecystectomy in the Acute Care Surgery model: risk factors for complications

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000312 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000312 ◽

Cited By ~ 2

Author(s):

Emily Fletcher ◽

Erica Seabold ◽

Karen Herzing ◽

Ronald Markert ◽

Alyssa Gans ◽

...

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Acute Care ◽

Postoperative Bleeding ◽

Organ Injury ◽

Acute Care Surgery ◽

Biliary Disease ◽

Significant Relationships ◽

Conversion Rates ◽

Care Surgery

BackgroundThe Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting.MethodsAll patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher’s exact test, χ2 test, and Mann-Whitney U Test.ResultsDuring the study period, 547 patients (70.2% female, mean age 46.1±18.1, mean body mass index 32.4±7.8 kg/m2) had LC performed for various acute indications. Mean surgery time was 77.9±50.2 minutes, and 5.7% of cases were performed “after hours.” Rate of conversion to open procedure was 6%. Complications seen included minor bile leaks (3.8%), infection (3.8%), retained gallstones (1.1%), organ injury (1.1%), major duct injury (0.9%), and postoperative bleeding (0.9%). Statistical analysis demonstrated significant relationships between conversion, length of surgery, age, gender, and intraoperative cholangiogram with various complications. No significant relationships were detected between complications and BMI, pregnancy, attending experience, and time of operation.DiscussionAlthough several statistically significant relationships were identified between several risk factors and complications, these findings have limited clinical significance. Factors including attending years in practice and time of the operation were not associated with increased complications. ACS services are capable of performing a high volume of LCs for emergent indications with low complication and conversion rates.Level of evidence:IV

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Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings

Frontiers in Surgery ◽

10.3389/fsurg.2021.754059 ◽

2021 ◽

Vol 8 ◽

Author(s):

Andrea Romanzi ◽

Gaetano Gallo ◽

Sabrina De Rango ◽

Barbara Vignati ◽

Alberto Vannelli

Keyword(s):

Intensive Care ◽

Colorectal Surgery ◽

General Anaesthesia ◽

Acute Care ◽

Vital Signs ◽

Case Series ◽

Acute Care Surgery ◽

Social Distancing ◽

Containment Measures ◽

Care Surgery

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients.Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative “cuddle delivery” service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital.Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The “cuddle delivery” initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain.Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.

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Impact of an acute care surgery service on timeliness of care and surgeon satisfaction at a Canadian academic hospital: a retrospective study

World Journal of Emergency Surgery ◽

10.1186/1749-7922-9-4 ◽

2014 ◽

Vol 9 (1) ◽

pp. 4 ◽

Cited By ~ 24

Author(s):

Kerollos N Wanis ◽

Allison M Hunter ◽

Michael B Harington ◽

Gary Groot

Keyword(s):

Retrospective Study ◽

Acute Care ◽

Acute Care Surgery ◽

Academic Hospital ◽

Timeliness Of Care ◽

Care Surgery ◽

Surgeon Satisfaction

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Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era—Minimizing the Patient's Delayed Presentation Factor

Journal of Surgical Research ◽

10.1016/j.jss.2019.01.031 ◽

2019 ◽

Vol 238 ◽

pp. 113-118 ◽

Cited By ~ 2

Author(s):

Narong Kulvatunyou ◽

Steven A. Zimmerman ◽

Bellal Joseph ◽

Randall S. Friese ◽

Lynn Gries ◽

...

Keyword(s):

Risk Factors ◽

Acute Care ◽

Perforated Appendicitis ◽

Acute Care Surgery ◽

Delayed Presentation ◽

Care Surgery

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Acute Care Surgery Billing, Coding and Documentation Series Part 3: Coding of Additional Select Procedures; Modifiers; Telemedicine Coding; Robotic Surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000587 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000587

Author(s):

Thomas Esposito ◽

Robert Reed ◽

Raeanna C Adams ◽

Samir Fakhry ◽

Dolores Carey ◽

...

Keyword(s):

Complex System ◽

Robotic Surgery ◽

Acute Care ◽

Acute Care Surgery ◽

Formal Training ◽

Experienced Surgeon ◽

Care Surgery

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work “smarter, not harder” and garner the maximum compensation for their work. We hope we have been successful in achieving and that goal that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This third section deals with coding of additional select procedures, modifiers, telemedicine coding, and robotic surgery.

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