Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study
| Autor: | David A Cromwell, H Boyd-Carson, Brett Doleman, John P. Williams, G. M. Tierney, J. N. Lund, Sonia Lockwood, Iain D. Anderson |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Logistic regression Time-to-Treatment Cohort Studies 03 medical and health sciences 0302 clinical medicine Risk Factors Laparotomy Medicine Humans Risk factor Aged Aged 80 and over business.industry Mortality rate Confounding Middle Aged Logistic Models 030220 oncology & carcinogenesis Emergency medicine Peptic Ulcer Perforation 030211 gastroenterology & hepatology Surgery Every Hour Female Emergencies business Abdominal surgery Cohort study |
| Zdroj: | World journal of surgery. 44(3) |
| ISSN: | 1432-2323 |
| Popis: | Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU). All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24 h of admission from December 2013 to November 2017 were included. Time to theatre from admission was modelled as a continuous variable in hours. Outcome was 90-day mortality. Logistic regression adjusting for confounding factors was performed. 3809 patients were included, and 90-day mortality rate was 10.61%. Median time to theatre was 7.5 h (IQR 5–11.6 h). The odds of death increased with time to operation once adjustment for confounding variables was performed (per hour after admission adjusted OR 1.04 95% CI 1.02–1.07). In patients who were physiologically shocked (N = 334), there was an increase of 6% in risk-adjusted odds of mortality for every hour Em Lap was delayed after admission (OR 1.06 95% CI 1.01–1.11). Hourly delay to theatre in patients with PPU is independently associated with risk of death by 90 days. Therefore, we suggest that surgical source control should occur as soon as possible after admission regardless of time of day. |
| Databáze: | OpenAIRE |
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