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Observational Study
. 2022 Jan:97:106168.
doi: 10.1016/j.ijsu.2021.106168. Epub 2021 Nov 14.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

C Villodre  1 , L Taccogna, P Zapater, M Cantó, L Mena, J M Ramia, F Lluís, N Afonso, V Aguilella, J Aguiló, J C Alados, M Alberich, A B Apio, R Balongo, E Bra, A Bravo-Gutiérrez, F J Briceño, J Cabañas, G Cánovas, I Caravaca, S Carbonell, E Carrera-Dacosta, E E Castro, C Caula, E Choolani-Bhojwani, A Codina, S Corral, C Cuenca, Y Curbelo-Peña, M M Delgado-Morales, L Delgado-Plasencia, E Doménech, A M Estévez, A M Feria, M A Gascón-Domínguez, R Gianchandani, C González, R J Hevia, M A González, J M Hidalgo, M Lainez, N Lluís, F López, J López-Fernández, J A López-Ruíz, P Lora-Cumplido, Z Madrazo, J Marchena, Marenco B de la Cuadra, S Martín, Martínez I Casas, P Martínez, A Mena-Mateos, D Morales-García, C Mulas, E Muñoz-Forner, A Naranjo, A Navarro-Sánchez, I Oliver, I Ortega, R Ortega-Higueruelo, S Ortega-Ruiz, J Osorio, M H Padín, J J Pamies, M Paredes, F Pareja-Ciuró, J Parra, C V Pérez-Guarinós, B Pérez-Saborido, J Pintor-Tortolero, K Plua-Muñiz, M Rey, I Rodríguez, C Ruiz, R Ruíz, S Ruiz, A Sánchez, D Sánchez, R Sánchez, F Sánchez-Cabezudo, R Sánchez-Santos, J Santos, M P Serrano-Paz, V Soria-Aledo, L Tallón-Aguilar, J H Valdivia-Risco, H Vallverdú-Cartié, C Varela, J Villar-Del-Moral, N Zambudio; LUCENTUM Project Researchers
Affiliations
Free article
Observational Study

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

C Villodre et al. Int J Surg. 2022 Jan.
Free article

Abstract

Background and aims: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures.

Methods: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator.

Results: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity.

Conclusions: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Keywords: Benchmarking; Emergency general surgery; Quality improvement; Risk-prediction.

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