Reducing Health Care Burden of Emergency General Surgery with a 24-Hour Dedicated Emergency General Surgery Service

2021 ◽  
pp. 000313482110562
Author(s):  
J. David Roy ◽  
W. Johnson Hardy ◽  
Morgan E. Roberts ◽  
Joseph E. Stahl ◽  
C. Caleb Butts ◽  
...  
Keyword(s):  
General Surgery ◽  
Complication Rate ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Primary Outcome Measure ◽  
Emergency General Surgery ◽  
Service Line ◽  
Health Care Burden ◽  
Secondary Endpoints ◽  
Individual Complication

Background Emergency general surgery (EGS) diagnoses account for 11% of surgical admissions and 50% of surgical mortality. In this population, 7 specific operations are associated with 80.3% of deaths, 78.9% of complications, and 80.2% of hospital costs. In 2016, our institution established a comprehensive in-house EGS service. Herein, we hypothesize that formation of a dedicated EGS service is associated with a significant reduction in morbidity for patients undergoing the most common EGS procedures. Methods All patients undergoing one of the most common EGS procedures within 2 days of admission were identified from 1/1/2013 to 5/9/2019 via a retrospective chart review. Patients were cohorted as pre- and post-EGS implementation. The primary outcome measure was the overall complication rate. Secondary endpoints included mortality, individual complication rate, time to operation, overnight operation, and length of stay. Finally, both cohorts were benchmarked to national outcomes. Results 718 patients met inclusion criteria (pre-EGS = 409 and post-EGS = 309). Overall complication rate decreased significantly (19.8% vs 13.9%, P = .0387) and overnight operations increased significantly in the post-EGS group (7.8%-16.5%, P = .0003). Pre-EGS complications were higher than national data in all but 1 procedure group, whereas post-EGS complications rates were lower in all but 2 categories. Discussion Implementation of a dedicated EGS service line was associated with a significant decrease in complication rate among the most complication-prone EGS procedures. Number of operations within 24 hours did not increase significantly; however, overnight operations did increase. Our results indicate that establishing a service-specific EGS line is reasonable and beneficial.

scholarly journals 1369 Clinical Outcomes in Patients Undergoing Emergency General Surgery During the Covid-19 Pandemic Versus Control Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Hebding ◽  
L Wingfield ◽  
Y Negreskul ◽  
J Gilmour
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Hospital Stay ◽  
General Surgery ◽  
Complication Rate ◽  
Emergency Surgery ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Emergency General Surgery ◽  
Significant Difference

Abstract Introduction Throughout the Covid-19 pandemic, the surgical community has attempted to address whether it is safe to continue surgery. The aim of this research was to review evidence on emergency general patients operated on during the pandemic compared to patients undergoing emergency surgery during non-pandemic times to determine if operating during the Covid-19 pandemic led to an increased risk of death, length of hospital stay and complications. Method A systematic review of the literature was performed. PubMed, Cochrane, MEDLINE, Science Direct, Springer Link, Elsevier, and reference lists were analysed for inclusion on 2 January 2021. Results Nine studies and 5,022 patients were included. There were no significant differences in the control group vs pandemic group in mean age (52.3yrs vs 51.9yrs, p = 0.67) or gender (44.4% females vs 49.3%, p = 0.173). Pooled analysis of control vs pandemic showed a mortality rate of 1.26% vs 3.06% (CI:-6.58–6.58, p = 1.00). Mean length of hospital stay was 7.9 vs 7.7 days in control v. pandemic (CI: -2.93-3.33, p = 0.87) and post-operative complication rate of 20.2% vs 25.7% (CI -6.4-25.0, p = 0.20), (control vs pandemic). The pandemic group had significantly more operative management (47.0% vs 40.0%, p = 0.03) with no significant difference in laparoscopic vs open technique (46.0% vs 43.6%, p = 0.20). Conclusions This meta-analysis shows there is no statistically significant difference in mortality rate, length of hospital stay and postoperative complication rate between the pandemic and control cohorts in emergency general surgery patients. This data suggests that general emergency surgery should continue in spite of the pandemic with appropriate precautions in place.

scholarly journals Pre-operative fluid resuscitation in the emergency general surgery septic patient: does it really matter?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin Moran ◽  
Erin Major ◽  
Joseph A. Kufera ◽  
Samuel A. Tisherman ◽  
Jose Diaz
Keyword(s):  
Relative Risk ◽  
Regression Model ◽  
Organ Failure ◽  
Fluid Resuscitation ◽  
General Surgery ◽  
Retrospective Chart Review ◽  
Scoring Systems ◽  
Abdominal Sepsis ◽  
Source Control ◽  
Emergency General Surgery

Abstract Objective Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30 mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes. Methods We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24 h of admission. Patients in hemorrhagic shock and those with outside hospital index surgeries were excluded. We grouped patients by increasing pre-operative resuscitation volume in 10 ml/kg intervals up to > 70 ml/kg and later grouped them into < 30 ml/kg or ≥ 30 ml/kg. A relative risk regression model compared amounts of fluid administration. Mortality was the primary outcome measure. Secondary outcomes were time to operation, ventilator days, and length of stay (LOS). Groups were compared by quick Sequential Organ Failure Assessment (qSOFA) and SOFA scoring systems. Results Of the 301 patients included, the mean age was 55, 51% were male, 257 (85%) survived to discharge. With increasing fluid per kg (< 10 to < 70 ml/kg), there was an increasing mortality per decile, 8.8% versus 31.6% (p = 0.004). Patients who received < 30 mL/kg had lower mortality (11.3 vs 21%) than those who received > 30 ml/kg (p = 0.02). These groups had median qSOFA scores (1.0 vs. 1.0, p = 0.06). There were no differences in time to operation (6.1 vs 4.9 h p = 0.11), ventilator days (1 vs 3, p = 0.08), or hospital LOS (8 vs 9 days, p = 0.57). Relative risk regression correcting for age and physiologic factors showed no significant differences in mortality between the fluid groups. Conclusions Greater pre-operative resuscitation volumes were initially associated with significantly higher mortality, despite similar organ failure scores. However, fluid volumes were not associated with mortality following adjustment for other physiologic factors in a regression model. The amount of pre-operative volume resuscitation was not associated with differences in time to operation, ventilator days, ICU or hospital LOS.

scholarly journals Pre-Operative Fluid Resuscitation in the Emergency General Surgery Septic Patient: Does it Really Matter?

2021 ◽  
Author(s):  
Benjamin J Moran ◽  
Erin Major ◽  
Joseph A Kufera ◽  
Samuel A Tisherman ◽  
Jose Diaz
Keyword(s):  
Relative Risk ◽  
Regression Model ◽  
Organ Failure ◽  
Fluid Resuscitation ◽  
General Surgery ◽  
Retrospective Chart Review ◽  
Scoring Systems ◽  
Abdominal Sepsis ◽  
Source Control ◽  
Emergency General Surgery

Abstract Objective: Emergency general surgery (EGS) patients presenting with sepsis remain a challenge. The Surviving Sepsis Campaign recommends a 30 mL/kg fluid bolus in these patients, but recent studies suggest an association between large volume crystalloid resuscitation and increased mortality. The optimal amount of pre-operative fluid resuscitation prior to source control in patients with intra-abdominal sepsis is unknown. This study aims to determine if increasing volume of resuscitation prior to surgical source control is associated with worsening outcomes. Methods: We conducted an 8-year retrospective chart review of EGS patients undergoing surgery for abdominal sepsis within 24 hours of admission. Patients in hemorrhagic shock and those with outside hospital index surgeries were excluded. We grouped patients by increasing pre-operative resuscitation volume in 10 ml/kg intervals up to >70 ml/kg and later grouped them into <30ml/kg or ≥30ml/kg. A relative risk regression model compared amounts of fluid administration. Mortality was the primary outcome measure. Secondary outcomes were time to operation, ventilator days, and length of stay (LOS). Groups were compared by quick Sequential Organ Failure Assessment (qSOFA) and SOFA scoring systems. Results: Of the 301 patients included, the mean age was 55, 51% were male, 257 (85%) survived to discharge. With increasing fluid per kg (<10 to <70ml/kg), there was an increasing mortality per decile, 8.8% versus 31.6% (p=0.004). Patients who received <30 mL/kg had lower mortality (11.3 vs 21%) than those who received >30 ml/kg (p=0.02). These groups had median qSOFA scores (1.0 vs. 1.0, p=0.06). There were no differences in time to operation (6.1 vs 4.9 hours p=0.11), ventilator days (1 vs 3, p=0.08), or hospital LOS (8 vs 9 days, p=0.57). Relative risk regression correcting for age and physiologic factors showed no significant differences in mortality between the fluid groups. Conclusions: Greater pre-operative resuscitation volumes were initially associated with significantly higher mortality, despite similar organ failure scores. However, fluid volumes were not associated with mortality following adjustment for other physiologic factors in a regression model. The amount of pre-operative volume resuscitation was not associated with differences in time to operation, ventilator days, ICU or hospital LOS.

scholarly journals 606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Dean ◽  
J Duncan
Keyword(s):  
Cohort Study ◽  
Upper Limb ◽  
Complication Rate ◽  
Postoperative Mortality ◽  
Primary Outcome Measure ◽  
Pulmonary Complications ◽  
Related Complication ◽  
Urgent Surgery ◽  
Upper Limb Surgery ◽  
The Uk

Abstract Introduction This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK. Method This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. Results This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive. Conclusions The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.

Appraising the Quality of Reporting of American College of Surgeons NSQIP Emergency General Surgery Studies

2021 ◽  
Vol 232 (5) ◽  
pp. 671-680 ◽  
Author(s):  
Mohamad El Moheb ◽  
Hadi Sabbagh ◽  
Daniel Badin ◽  
Tala Mahmoud ◽  
Basil Karam ◽  
...  
Keyword(s):  
General Surgery ◽  
Emergency General Surgery ◽  
Quality Of Reporting ◽  
American College Of Surgeons

scholarly journals 892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Hashmi ◽  
S Khalid ◽  
K Raja ◽  
A Zaka ◽  
J Easterbrook
Keyword(s):  
Informed Consent ◽  
Royal College ◽  
Mortality Risk ◽  
General Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Surgical Practice ◽  
Full Compliance ◽  
Type Of Surgery

Abstract Introduction COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic. Method Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined. Results Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02). Conclusions RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

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