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Objective: Emergency general surgery (EGS) patients are more likely to die and suffer complications than non-EGS patients. Seven procedures have recently been shown to account for 80% of the National burden of EGS, but the risk associated with an emergency designation among this group has not been evaluated. We aimed to define the excess morbidity and mortality attributable to these procedures.
Design: The American College of Surgeons NSQIP database (2005-2014) was queried for seven EGS procedures (appendectomy, cholecystectomy, laparotomy, colectomy, small bowel resection, peptic ulcer repair and lysis of adhesions). EGS was defined as a case with emergency designation and surgery within 48 hours of admission. Multivariate logistic regression was performed.
Setting: NSQIP includes aggregate data from participating facilities, which include academic, community, and tertiary centers.
Patients: All cases with primary common procedural terminology (CPT) codes from the 7 procedures in the NSQIP database from 2005-2014 and ≥18. Patient data was de-identified.
Main Outcome Measures: Odds Ratios (95%CI) for overall mortality, overall morbidity and major morbidity.
Results: 619,174 patients were identified. EGS was an independent predictor of overall mortality (OR 1.38, CI [1.32,1.43}), overall morbidity (OR 1.09, CI [1.07,1,11]), and major morbidity (OR 1.21, CI [1.19,1.24]). Subset analysis excluding appendectomy and cholecystectomy had an overall mortality OR of 1.38(1.33,1.45), overall morbidity OR of 1.13 (1.11,1.16), and major morbidity OR of 1.24(1.21,1.28).
Conclusions: Amongst the seven EGS procedures representing the greatest national burden, emergency designation is an independent risk factor for morbidity and mortality. Further study of causes of these risks and systems to modify them are needed to address this excess mortality and morbidity.