BACKGROUND: Emergency surgical services in Edinburgh were restructured in July 2002 to deliver subspecialist management of colorectal and upper-gastrointestinal emergencies on separate sites. The effect of emergency subspecialization on outcome from perforated and bleeding peptic ulceration was assessed. METHODS: All patients admitted with complicated peptic ulceration (January 2000-February 2005) were identified from a prospectively compiled database. RESULTS: Perforation: 148 patients were admitted with perforation before the service reorganization (period A - 31 months) of whom 126 (85.1%) underwent surgery; 135 patients were admitted in period B (31 months) of whom 114 (84.4%) were managed operatively. The in-hospital mortality was lower in period B (14/135, 10.4%) than period A (30/148, 20.3%; P = 0.023; relative risk (RR), 0.51; 95% confidence interval (CI), 0.28-0.91). There was a significantly higher rate of gastric resection in the second half of the study (period A 1/126 vs. period B 8/114; P = 0.015; RR, 8.84; 95% CI, 1.48-54.34). Length of hospital stay was similar for both groups. Bleeding: 51 patients underwent operative management of bleeding peptic ulceration in period A and 51 in period B. There were no differences in length of stay or mortality between these two groups. CONCLUSION: Restructuring of surgical services with emergency subspecialization was associated with lower mortality for perforated peptic ulceration. Subspecialist experience, intraoperative decision-making, and improved postoperative care have all contributed to this improvement.
BACKGROUND: Emergency surgical services in Edinburgh were restructured in July 2002 to deliver subspecialist management of colorectal and upper-gastrointestinal emergencies on separate sites. The effect of emergency subspecialization on outcome from perforated and bleeding peptic ulceration was assessed. METHODS: All patients admitted with complicated peptic ulceration (January 2000-February 2005) were identified from a prospectively compiled database. RESULTS: Perforation: 148 patients were admitted with perforation before the service reorganization (period A - 31 months) of whom 126 (85.1%) underwent surgery; 135 patients were admitted in period B (31 months) of whom 114 (84.4%) were managed operatively. The in-hospital mortality was lower in period B (14/135, 10.4%) than period A (30/148, 20.3%; P = 0.023; relative risk (RR), 0.51; 95% confidence interval (CI), 0.28-0.91). There was a significantly higher rate of gastric resection in the second half of the study (period A 1/126 vs. period B 8/114; P = 0.015; RR, 8.84; 95% CI, 1.48-54.34). Length of hospital stay was similar for both groups. Bleeding: 51 patients underwent operative management of bleeding peptic ulceration in period A and 51 in period B. There were no differences in length of stay or mortality between these two groups. CONCLUSION: Restructuring of surgical services with emergency subspecialization was associated with lower mortality for perforated peptic ulceration. Subspecialist experience, intraoperative decision-making, and improved postoperative care have all contributed to this improvement.
Authors: Reimar W Thomsen; Anders Riis; Estrid M Munk; Mette Nørgaard; Steffen Christensen; Henrik T Sørensen Journal: Am J Gastroenterol Date: 2006-10-06 Impact factor: 10.864
Authors: J Y Lau; J J Sung; Y H Lam; A C Chan; E K Ng; D W Lee; F K Chan; R C Suen; S C Chung Journal: N Engl J Med Date: 1999-03-11 Impact factor: 91.245
Authors: Thomas E Read; Robert J Myerson; James W Fleshman; Robert D Fry; Elisa H Birnbaum; Bruce J Walz; Ira J Kodner Journal: Dis Colon Rectum Date: 2002-07 Impact factor: 4.585
Authors: Anne Nakano; Jørgen Bendix; Sven Adamsen; Daniel Buck; Jan Mainz; Paul Bartels; Bente Nørgård Journal: Risk Manag Healthc Policy Date: 2008-11-30