scholarly journals Outcomes of COVID-19 patients that needed emergency general surgery: predictors of mortality and postoperative complications

2021 ◽  
Author(s):  
Katya Bozada-Gutiérrez ◽  
Mario Trejo-Avila ◽  
Carlos Valenzuela-Salazar ◽  
Jesús Herrera-Esqu ◽  
Mucio Moreno-Portillo
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
General Surgery ◽  
Perioperative Outcomes ◽  
Emergency General Surgery ◽  
Entire Cohort ◽  
Prolonged Length ◽  
Symptomatic Disease ◽  
Predictors Of Mortality ◽  
Prediction Of Mortality

Abstract Purpose There is limited data about the perioperative outcomes of COVID−19 patients that needed emergency general surgery. The aims of the present study were to describe the perioperative outcomes of COVID−19 patients that underwent emergency general surgery and to determine possible predictors of mortality and postoperative complications. Methods A prospective study of positive COVID−19 patients that needed an emergency general surgery procedure at our center was performed. Results From March 2020 to February 2021, 44 patients were included. We found that patients with SARS-CoV−2 symptomatic disease have increased postoperative complications, higher ICU admissions, prolonged length of stay, and decreased 90-day survival as compared with asymptomatic COVID−19 patients. The 90-day survival probability of the entire cohort was 70.1% (60.3–79.9) and was significantly lower in patients with COVID−19 symptoms 63.4% (50.5–76.2). We found the following cut-off values for the prediction of mortality: ferritin ≥ 438.5 ng/mL (AUC = 0.908), CRP value ≥ 12.5 mg/dL (AUC = 0.715), leukocyte ≥ 13.8 x103/µL (AUC = 0.706), and albumin ≤ 2.78 g/dL (AUC = 704,). Also, a cut-off value of CRP of ≥ 12.5 mg/dL yielded an accuracy of 82.9% for the prediction of postoperative complications (p < 0.001). Conclusion Patients with symptomatic COVID−19 that needed emergency surgery have increased postoperative complications, higher ICU admissions, prolonged length of stay, and decreased 90-day survival as compared with asymptomatic COVID−19 patients. Preoperative ferritin, CRP, leukocytes, and albumin could be used as predictors of mortality.

scholarly journals Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

2014 ◽  
Vol 8 (3-4) ◽  
pp. 100 ◽  
Author(s):  
Akshay Sood ◽  
Hanhan Li ◽  
Jesse Sammon ◽  
Florian Roghmann ◽  
Michael Ehlert ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Length Of Stay ◽  
Intraoperative Complications ◽  
Pelvic Organ ◽  
Vaginal Vault ◽  
Hospital Charges ◽  
Perioperative Outcomes ◽  
Vaginal Vault Suspension ◽  
Prolonged Length ◽  
Vault Suspension

Objectives: Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS.Methods: RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges.Results: Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications.Conclusions: The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intraoperative complications.

scholarly journals TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Anthony Chan ◽  
Panos Stathakis ◽  
Paul Goldsmith ◽  
Stella Smith ◽  
Christian Macutkiewicz
Keyword(s):  
General Surgery ◽  
Lower Proportion ◽  
University Teaching ◽  
Perioperative Outcomes ◽  
Delayed Presentation ◽  
Global Public Health ◽  
Emergency General Surgery ◽  
Duration Of Symptoms ◽  
Co Morbidity ◽  
The Uk

Abstract Background The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes. Method This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes. Results A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p &lt; 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). Conclusion We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.

scholarly journals Morning report decreases length of stay in emergency general surgery patients

2019 ◽  
Vol 8 (6) ◽  
pp. 1
Author(s):  
James R. Gardner ◽  
John D. Wolfe ◽  
William C. Beck ◽  
Kevin W. Sexton ◽  
Avi Bhavaraju ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Surgery ◽  
Average Length ◽  
Hospital Setting ◽  
Acute Care Surgery ◽  
Morning Report ◽  
Emergency General Surgery ◽  
Medical Specialties ◽  
Surgical Critical Care ◽  
Care Surgery

Objective: Communication in the hospital setting is an easy target for quality improvement. Capturing this change via communication between providers during hand-offs is necessary to reduce delays and errors. While this process has been more widely characterized in medical specialties, we designed this study to address the knowledge gap in surgical specialties.Methods: Our institution’s division of Acute Care Surgery (ACS) implemented Morning Report (MR) in October of 2015. At MR, all admissions and service transfers were discussed from Trauma, Emergency General Surgery (EGS), and Surgical Critical Care services from the previous 24 hours. This study compared patients who underwent a surgical procedure during their hospital stay before and after protocol implementation.Results: 974 patients were included in this study. The average patient was 50.3 years of age, 65.4% were white, and 51.7% were male. The average length of stay (LOS) was 8.3 days with 1.75 days to procedure. The post-MR cohort LOS was 2.7 shorter and had 0.85 fewer days to procedure. In an adjusted regression analysis, days to procedure and LOS decreased by 33% (p < .01) and 17% (p < .01) respectively.Conclusions: Implementation of MR led to a decrease in the overall LOS and days to procedure for operative patients. Our results advocate for the standard use of structured hand-offs in surgical units.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

2015 ◽  
Vol 81 (8) ◽  
pp. 755-759 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John C. Kubasiak ◽  
Imke Janssen ◽  
Jonathan A. Myers ◽  
Minh B. Luu
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Postoperative Complication ◽  
General Surgery ◽  
Meld Score ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Umbilical Hernia Repair ◽  
The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

scholarly journals Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

2014 ◽  
Vol 8 (9-10) ◽  
pp. 695 ◽  
Author(s):  
Vincent Trudeau ◽  
Giorgio Gandaglia ◽  
Jonas Shiffmann ◽  
Ioana Popa ◽  
Shahrokh F Shariat ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Perioperative Complications ◽  
Large Population ◽  
Laparoscopic Approach ◽  
Population Based ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Lower Probability ◽  
Weighted Estimate ◽  
Prolonged Length

Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large population-based cohort of patients with upper-tract urothelial carcinoma (UTUC).Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures.Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade.Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU.

Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care

2019 ◽  
Vol 87 (2) ◽  
pp. 408-412 ◽  
Author(s):  
Aditya Achanta ◽  
Ask Nordestgaard ◽  
Napaporn Kongkaewpaisan ◽  
Kelsey Han ◽  
April Mendoza ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
General Surgery ◽  
Clinical Factors ◽  
Emergency General Surgery

Impact of specific postoperative complications on the outcomes of emergency general surgery patients

2015 ◽  
Vol 78 (5) ◽  
pp. 912-919 ◽  
Author(s):  
Christopher Cameron McCoy ◽  
Brian R. Englum ◽  
Jeffrey E. Keenan ◽  
Steven N. Vaslef ◽  
Mark L. Shapiro ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
General Surgery ◽  
Emergency General Surgery

scholarly journals Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score

2020 ◽  
Author(s):  
William J. Doherty ◽  
Thomas A. Stubbs ◽  
Andrew Chaplin ◽  
Mike R. Reed ◽  
Avan A. Sayer ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Functional Independence ◽  
Risk Scores ◽  
Mental Test Score ◽  
Hip Fracture Surgery ◽  
Independent Validation ◽  
Predictive Variables ◽  
Prediction Of Mortality

Objectives Independent validation of risk scores after hip fracture is uncommon, particularly for evaluation of outcomes other than death. We aimed to assess the Nottingham Hip Fracture Score (NHFS) for prediction of mortality, physical function, length of stay and postoperative complications. Design Analysis of routinely collected prospective data partly collected by follow-up interviews. Setting and Participants Consecutive hip fracture patients were identified from the Northumbria hip fracture database between 2014-2018. Patients were excluded if they were not surgically managed or if scores for predictive variables were missing. Methods C-statistics were calculated to test the discriminant ability of the NHFS, Abbreviated Mental Test Score (AMTS), and ASA grade for in-hospital, 30- and 120-day mortality, functional independence at discharge, 30-days and 120-days, length of stay, and postoperative complications. Results We analysed data from 3208 individuals, mean age 82.6 (SD 8.6). 2192 (70.9%) were female. 194 (6.3%) died during the first 30-days, 1686 (54.5%) were discharged to their own home, 211 (6.8%) had no mobility at 120-days, 141 (4.6%) experienced a postoperative complication. The median length of stay was 18 days (IQR 8-28). For mortality, c-statistics for the NHFS ranged from 0.68-0.69, similar to ASA and AMTS. For postoperative mobility, the c-statistics for the NHFS ranged from 0.74-0.83, similar to AMTS (0.61-0.82) and better than the ASA grade (0.68-0.71). Length of stay was significantly correlated with each score (p&lt;0.001 by Jonckheere-Terpstra test); NHFS and AMTS showed inverted U-shaped relationships with length of stay. For postoperative complications, c-statistics for NHFS (0.54-0.59) were similar to ASA grade (0.53-0.61) and AMTS (0.50-0.58). Conclusions and Implications The NHFS performed consistently well in predicting functional outcomes, moderately in predicting mortality, but less well in predicting length of stay and complications. There remains room for improvement by adding further predictors such as measures of physical performance in future analyses.

scholarly journals SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward Hardy ◽  
Thomas Smart ◽  
Jacob Hatt ◽  
Jon Lund
Keyword(s):  
Length Of Stay ◽  
Perceived Stress ◽  
General Surgery ◽  
Surgical Care ◽  
Emergency General Surgery ◽  
Quality Of Patient Care ◽  
Stress Levels ◽  
General Surgeons ◽  
The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, &gt;4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, &gt; 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

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