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Comparative Study
. 2019 Jul 9;3(5):713-721.
doi: 10.1002/bjs5.50187. eCollection 2019 Oct.

Twenty-year study of in-hospital and postdischarge mortality following emergency general surgical admission

G Ramsay  1   2 , J M Wohlgemut  3   4 , J O Jansen  5
Affiliations
Comparative Study

Twenty-year study of in-hospital and postdischarge mortality following emergency general surgical admission

G Ramsay et al. BJS Open. .

Abstract
in English, Spanish

Background: Emergency general surgery (EGS) patients have a higher mortality than those having elective surgery. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates after discharge. The aim of this study was to conduct a comprehensive, population-based analysis of mortality in EGS patients over a 20-year time frame.

Methods: This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson Co-morbidity Index, and operations were coded by OPCS-4 classifications. Linear and multivariable logistic regression models were used to evaluate changes over time.

Results: Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and 1-year mortality rates were 1·8, 3·8, 6·4 and 12·5 per cent respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all P < 0·001), and improved with time on subgroup analysis by age, co-morbidity and operation status. Medium-term mortality was high: the 1-year mortality rate in patients aged over 75 years was 35·6 per cent. The 1-year mortality rate in highly co-morbid patients decreased from 75·1 to 57·1 per cent over the time frame of the study (P < 0·001).

Conclusion: Mortality after EGS in Scotland has reduced significantly over the past 20 years. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates, and postdischarge death rates are higher than is currently appreciated.

Antecedentes: Los pacientes sometidos a cirugía general urgente (emergency general surgery, EGS) presentan una mortalidad más elevada que los pacientes sometidos a cirugía electiva. Pocos estudios han investigado los cambios en la mortalidad asociada a la EGS a lo largo del tiempo o han analizado las tasas de mortalidad tras el alta hospitalaria. El objetivo de este estudio fue llevar a cabo un análisis exhaustivo de base poblacional de la mortalidad en pacientes en EGS durante un horizonte temporal de 20 años.

Métodos: Se trata de un estudio transversal de todos los ingresos de adultos por EGS en Escocia entre 1996 y 2015. Los datos se obtuvieron de los registros nacionales. Las comorbilidades se definieron según el índice de comorbilidad de Charlson y las operaciones se codificaron con las clasificaciones OPCS4. Se utilizaron modelos de regresión logística lineal y multivariante para evaluar cambios a los largo del tiempo.

Resultados: En un total de 1.450.296 pacientes, las tasas globales de mortalidad hospitalaria, a los 30 días, 90 días y un año fueron de 1,8%, 3,8%, 6,4% y 12,5%, respectivamente. La mortalidad estaba influida por la edad en el momento del ingreso, comorbilidad, la intervención quirúrgica realizada y la fecha de ingreso (todas las variables P < 0,001) y mejoró con el tiempo en el análisis por subgrupos de edad, comorbilidad e intervenciones quirúrgicas. La mortalidad a medio plazo fue elevada: la tasa de mortalidad a un año en pacientes mayores de 75 años fue de 35,6%. La mortalidad a un año en pacientes con elevada morbilidad disminuyó de un 75% a un 57% a lo largo del periodo del estudio (P < 0,001).

Conclusión: La mortalidad tras EGS en Escocia ha disminuido significativamente a lo largo de los últimos 20 años. No obstante, el análisis de la mortalidad a medio plazo después de un ingreso por EGS demuestra unas tasas sorprendentemente elevadas y, por ello, actualmente hay que tener en cuenta la mortalidad tras el alta de forma especial.

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Figures

Figure 1
Figure 1
Mortality of emergency general surgery patients over time, stratified by age group a All age groups; b age 16–30 years; c age 31–45 years; d age 46–60 years; e age 61–75 years; f age over 75 years. Results of the linear regression analysis, including slope, 95 per cent c.i. and P values, are shown in Table  S2 (supporting information).
Figure 2
Figure 2
Mortality of emergency general surgery patients over time, by operative status during index admission a Inpatient mortality; b 30‐day mortality; c 90‐day mortality; d 1‐year mortality. Results of the linear regression analysis, including slope, 95 per cent c.i. and P values, are shown in Table  S3 (supporting information).
Figure 3
Figure 3
Mortality of emergency general surgery patients over time, by Charlson Co‐morbidity Index a Inpatient mortality; b 30‐day mortality; c 90‐day mortality; d 1‐year mortality. CCI, Charlson Co‐morbidity Index. Results of the linear regression, including slope, 95 per cent c.i. and P values, are shown in Table  S4 (supporting information).
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