Importance of Radiologists in Optimizing Outcomes for Older Americans with Acute Abdomen.

Autor: Ricci KB; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Oslock WM; The Ohio State University College of Medicine, Columbus, Ohio., Ingraham AM; Department of Surgery, University of Wisconsin, Madison, Wisconsin., Rushing AP; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Diaz A; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Paredes AZ; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Daniel VT; Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts., Collins CE; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Heh VK; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Baselice HE; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Strassels SA; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio., Caterino JM; Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio., Santry HP; Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio; Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, Columbus, Ohio. Electronic address: Heena.Santry@osumc.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2021 May; Vol. 261, pp. 361-368. Date of Electronic Publication: 2021 Jan 22.
DOI: 10.1016/j.jss.2020.12.022
Abstrakt: Background: Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. We investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or "acute abdomen," in older Americans.
Methods: Data from a 2015 national survey of 2811 hospitals regarding emergency general surgery structures and processes (60.1% overall response, n = 1690) were linked to 2015 Medicare inpatient claims data. We identified beneficiaries aged ≥65 admitted emergently with a confirmatory acute abdomen diagnosis code and operative intervention on the same calendar date. Multivariable regression models adjusted for significant covariates determined odds of complications and mortality based on CT resources.
Results: We identified 9125 patients with acute abdomen treated at 1253 hospitals, of which 78% had ≥64-slice CT scanners and 85% had 24/7 CT technicians. Overnight CT reads were provided by in-house radiologists at 14% of hospitals and by teleradiologists at 66%. Patients were predominantly 65-74 y old (43%), white (88%), females (60%), and with ≥3 comorbidities (67%) and 8.6% died. STAT radiology reads by a board-certified radiologist rarely/never available in 2 h was associated with increased odds of systemic complication and mortality (adjusted odds ratio 2.6 [1.3-5.4] and 2.3 [1.1-4.8], respectively).
Conclusions: Delays obtaining results are associated with adverse outcomes in older patients with acute abdomen. This may be due to delays in surgical consultation and time to source control while waiting for imaging results. Processes to ensure timely interpretation of CT scans in patients with abdominal pain may improve outcomes in high-risk patients.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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