Morten Vester-Andersen1, Lars Hyldborg Lundstrøm2, David Levarett Buck3, Morten Hylander Møller4. 1. a 1 Departments of Anaesthesiology and Intensive Care Medicine, Køge Hospital and Herlev Hospital , Herlev, Denmark. 2. b 2 Department of Anaesthesiology and Intensive Care Medicine, Nordsjællands Hospital , Hillerød, Denmark. 3. c 3 Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark. 4. d 4 Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark.
Abstract
OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general. MATERIAL AND METHODS: All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression. RESULTS: A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding. CONCLUSIONS: In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.
OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general. MATERIAL AND METHODS: All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression. RESULTS: A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding. CONCLUSIONS: In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.
Authors: Daniel I McIsaac; Karim Abdulla; Homer Yang; Sudhir Sundaresan; Paula Doering; Sandeep Green Vaswani; Kednapa Thavorn; Alan J Forster Journal: CMAJ Date: 2017-07-10 Impact factor: 8.262
Authors: Vijaya T Daniel; Amy P Rushing; Angela M Ingraham; Kevin B Ricci; Anghela Z Paredes; Adrian Diaz; M Didem Ayturk; Holly E Baselice; Scott A Strassels; Heena P Santry Journal: J Trauma Acute Care Surg Date: 2019-07 Impact factor: 3.313
Authors: Félix R Montes; Skarlet Marcell Vásquez; Claudia Marcela Camargo-Rojas; Myriam V Rueda; Lina Góez-Mogollón; Paula A Alvarado; Danny J Novoa; Juan Carlos Villar Journal: BMC Emerg Med Date: 2019-04-17
Authors: Tom Salih; Peter Martin; Tom Poulton; Charles M Oliver; Mike G Bassett; S Ramani Moonesinghe Journal: BMJ Qual Saf Date: 2020-06-23 Impact factor: 7.035
Authors: Deirdre M Nally; Jan Sørensen; Gintare Valentelyte; Laura Hammond; Deborah McNamara; Dara O Kavanagh; Ken Mealy Journal: BMJ Open Date: 2019-11-02 Impact factor: 2.692