Multiple Complications in Emergency Surgery : Identifying Risk Factors for Failure-to-Rescue.

Autor:	Hatchimonji JS; 6572 Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, PA, USA., Swendiman RA; 6572 Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, PA, USA., Kaufman EJ; 6572 Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Scantling D; 6572 Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA., Passman JE; 6572 Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, PA, USA., Yang W; 6572 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, PA, USA., Kit Delgado M; 6572 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, PA, USA.; 6572 Department of Emergency Medicine, Center for Emergency Care Policy and Research, Perelman School of Medicine at the University of Pennsylvania, PA, USA., Holena DN; 6572 Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.; 6572 Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, PA, USA.
Jazyk:	angličtina
Zdroj:	The American surgeon [Am Surg] 2020 Jul; Vol. 86 (7), pp. 787-795. Date of Electronic Publication: 2020 Jul 10.
DOI:	10.1177/0003134820934400
Abstrakt:	Background: While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death. Methods: We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac, renal, neurologic, or technical. We tabulated common combinations of complications. We then use logistic regression analyses to test the hypotheses that (1) increase in the number and frequency of complications would yield higher FTR rates and (2) secondary complications that span a greater number of organ systems or mechanisms carry a greater associated FTR risk. Results: Of 329 183 EGS patients, 69 832 (21.2%) experienced at least 1 complication. Of the 11 195 patients who died following complication (16.0%), 8205 (63.4%) suffered more than 1 complication. Multivariable regression analyses revealed an association between the number of complications and mortality risk (odds ratio [OR] 2.37 for 2 complications vs 1, P < .001). There was a similar increase in mortality with increased complication accrual rate (OR 3.29 for 0.2-0.4 complications/day vs <0.2, P < .001). Increasing the number of types of complication were similarly associated with mortality risk. Discussion: While past FTR analyses have focused primarily on index complication, a broader consideration of ensuing trajectory may enable identification of high-risk cohorts. Efforts to reduce mortality in EGS should focus on attention to those who suffer a complication to prevent a cascade of downstream complications culminating in death.
Databáze:	MEDLINE
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