Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals.

Autor: Montes FR; Departamento de Anestesiología, Fundación CardioInfantil- Instituto de Cardiología and Universidad del Rosario, Bogotá, Colombia., Vásquez SM; Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia., Camargo-Rojas CM; Departamento de Investigaciones, Fundación CardioInfantil- Instituto de Cardiología, Bogotá, Colombia., Rueda MV; Departamento de Medicina Interna, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga and Fundación Oftalmológica de Santander- Clínica FOSCAL, Bucaramanga, Colombia., Góez-Mogollón L; Departamento de Investigaciones, Fundación CardioInfantil- Instituto de Cardiología, Bogotá, Colombia., Alvarado PA; Departamento de Investigaciones, Fundación CardioInfantil- Instituto de Cardiología, Bogotá, Colombia., Novoa DJ; Departamento de Medicina Interna, Fundación CardioInfantil- Instituto de Cardiología and Universidad del Rosario, Bogotá, Colombia., Villar JC; Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia. jvillarc@cardioinfantil.org.; Departamento de Investigaciones, Fundación CardioInfantil- Instituto de Cardiología, Bogotá, Colombia. jvillarc@cardioinfantil.org.
Jazyk: angličtina
Zdroj: BMC emergency medicine [BMC Emerg Med] 2019 Apr 17; Vol. 19 (1), pp. 27. Date of Electronic Publication: 2019 Apr 17.
DOI: 10.1186/s12873-019-0241-6
Abstrakt: Background: In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories.
Methods: A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding.
Results: Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p < 0.001 for the interaction).
Conclusion: Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases.
Databáze: MEDLINE
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