1. Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients.
- Author
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Coimbra R, Kim M, Allison-Aipa T, Zakhary B, Kwon J, Firek M, Coimbra BC, Costantini TW, Haynes LN, and Edwards SB
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Risk Factors, Digestive System Surgical Procedures adverse effects, Digestive System Surgical Procedures mortality, Adult, Patient Readmission statistics & numerical data, Postoperative Complications epidemiology, Postoperative Complications mortality, Failure to Rescue, Health Care statistics & numerical data
- Abstract
Introduction: We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR., Methods: A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression., Results: Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR., Discussion: Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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