Skip to main content

Impact of specific postoperative complications on the outcomes of emergency general surgery patients.

Publication ,  Journal Article
McCoy, CC; Englum, BR; Keenan, JE; Vaslef, SN; Shapiro, ML; Scarborough, JE
Published in: J Trauma Acute Care Surg
May 2015

BACKGROUND: The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. METHODS: Patients from the 2005 to 2011 American College of Surgeons' National Surgical Quality Improvement Program database who underwent emergency operation by a general surgeon for one of seven diagnoses (gallbladder disease, gastroduodenal ulcer disease, intestinal ischemia, intestinal obstruction, intestinal perforation, diverticulitis, and abdominal wall hernia) were analyzed. Postoperative complications (pneumonia, myocardial infarction, incisional surgical site infection, organ/space surgical site infection, thromboembolic process, urinary tract infection, stroke, or major bleeding) were chosen based on surgical outcome measures monitored by national quality improvement initiatives and regulatory bodies. Regression techniques were used to determine the independent association between these complications and 30-day mortality, after adjustment for an array of patient- and procedure-related variables. RESULTS: Emergency operations accounted for 14.6% of the approximately 1.2 million general surgery procedures that are included in American College of Surgeons' National Surgical Quality Improvement Program but for 53.5% of the 19,094 postoperative deaths. A total of 43,429 emergency general surgery patients were analyzed. Incisional surgical site infection had the highest incidence (6.7%). The second most common complication was pneumonia (5.7%). Stroke, major bleeding, myocardial infarction, and pneumonia exhibited the strongest associations with postoperative death. CONCLUSION: Given its disproportionate contribution to surgical mortality, emergency surgery represents an ideal focus for quality improvement. Of the potential postoperative targets for quality improvement, pneumonia, myocardial infarction, stroke, and major bleeding have the strongest associations with subsequent mortality. Since pneumonia is both relatively common after emergency surgery and strongly associated with postoperative death, it should receive priority as a target for surgical quality improvement initiatives. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

May 2015

Volume

78

Issue

5

Start / End Page

912 / 918

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Surgical Procedures, Operative
  • Risk Factors
  • Retrospective Studies
  • Quality Assurance, Health Care
  • Prognosis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
McCoy, C. C., Englum, B. R., Keenan, J. E., Vaslef, S. N., Shapiro, M. L., & Scarborough, J. E. (2015). Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg, 78(5), 912–918. https://doi.org/10.1097/TA.0000000000000611
McCoy, Christopher Cameron, Brian R. Englum, Jeffrey E. Keenan, Steven N. Vaslef, Mark L. Shapiro, and John E. Scarborough. “Impact of specific postoperative complications on the outcomes of emergency general surgery patients.J Trauma Acute Care Surg 78, no. 5 (May 2015): 912–18. https://doi.org/10.1097/TA.0000000000000611.
McCoy CC, Englum BR, Keenan JE, Vaslef SN, Shapiro ML, Scarborough JE. Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg. 2015 May;78(5):912–8.
McCoy, Christopher Cameron, et al. “Impact of specific postoperative complications on the outcomes of emergency general surgery patients.J Trauma Acute Care Surg, vol. 78, no. 5, May 2015, pp. 912–18. Pubmed, doi:10.1097/TA.0000000000000611.
McCoy CC, Englum BR, Keenan JE, Vaslef SN, Shapiro ML, Scarborough JE. Impact of specific postoperative complications on the outcomes of emergency general surgery patients. J Trauma Acute Care Surg. 2015 May;78(5):912–918.

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

May 2015

Volume

78

Issue

5

Start / End Page

912 / 918

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Time Factors
  • Survival Rate
  • Surgical Procedures, Operative
  • Risk Factors
  • Retrospective Studies
  • Quality Assurance, Health Care
  • Prognosis