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44. Emergency General Surgery Quality Improvement: A Review of Recommended Structure and Key Issues.

Author

Ross, Samuel W FACS, Reinke, Caroline E MSHP, FACS, Ingraham, Angela M MS, FACS, Holena, Daniel N FACS, Havens, Joaquim M FACS, Hemmila, Mark R FACS, Sakran, Joseph V FACS, Staudenmayer, Kristan L FACS, Napolitano, Lena M FCCP, MCCM, FACS, Coimbra, Raul FACS, Ross, Samuel W, Reinke, Caroline E, Ingraham, Angela M, Holena, Daniel N, Havens, Joaquim M, Hemmila, Mark R, Sakran, Joseph V, Staudenmayer, Kristan L, Napolitano, Lena M, and Coimbra, Raul

Subjects
*SURGICAL emergencies, *HOSPITAL admission & discharge, *ABDOMINAL surgery, *GERIATRICS, *RESEARCH, *OPERATIVE surgery, *RESEARCH methodology, *ACQUISITION of data, *RETROSPECTIVE studies, *EVALUATION research, *HOSPITAL mortality, *MEDICAL emergencies, *COMPARATIVE studies, *HOSPITAL care, *QUALITY assurance, *RESEARCH funding
Abstract

Emergency general surgery (EGS) accounts for 11% of hospital admissions, with more than 3 million admissions per year and more than 50% of operative mortality in the US. Recent research into EGS has ignited multiple quality improvement initiatives, and the process of developing national standards and verification in EGS has been initiated. Such programs for quality improvement in EGS include registry formation, protocol and standards creation, evidenced-based protocols, disease-specific protocol implementation, regional collaboratives, targeting of high-risk procedures such as exploratory laparotomy, focus on special populations like geriatrics, and targeting improvements in high opportunity outcomes such as failure to rescue. The authors present a collective narrative review of advances in quality improvement structure in EGS in recent years and summarize plans for a national EGS registry and American College of Surgeons verification for this under-resourced area of surgery. [ABSTRACT FROM AUTHOR]

Published
2022
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50. The Obesity Paradox in Emergency General Surgery Patients.

Author

Maloney, Sean R., Reinke, Caroline E., Nimeri, Abdelrahman A., Ayuso, Sullivan A., Christmas, A. Britton, Hetherington, Timothy, Kowalkowski, Marc, Sing, Ronald F., May, Addison K., and Ross, Samuel Wade

Subjects
*OBESITY, *OPERATIVE surgery, *RETROSPECTIVE studies, *ACQUISITION of data, *LEANNESS, *BODY mass index, *OBESITY paradox
Abstract

Background: Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2 and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates.Methods: A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed.Results: A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9).Conclusions: When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings. [ABSTRACT FROM AUTHOR]

Published
2022
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