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Background: The risk of death after a postoperative complication--known as failure to rescue (FTR)--has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres. Methods: In this multicentre retrospective cohort study, we performed a secondary analysis of data from a previous study designed to evaluate operative intervention for nonappendiceal, nonbiliary disease by 6 EGS services across Canada (1 in British Columbia, 1 in Alberta, 3 in Ontario and 1 in Nova Scotia). Patients underwent surgery between Jan. 1 and Dec. 31, 2014. We conducted univariate analyses to compare patients with and without complications. We performed a sensitivity analysis examining the mortality rate after serious complications (Clavien-Dindo score 3 or 4) that required a surgical intervention or specialized care (e.g., admission to intensive care unit). Results: A total of 2595 patients were included in the study cohort. Of the 206 patients who died within 30 days, 145 (70.4%) experienced a complication before their death. Overall, the mortality rate after any surgical complication (i.e., FTR) was 16.0%. Ranking of sites by the traditional outcomes of complication and mortality rates differed from the ranking when FTR rate was included in the assessment. Conclusion: There was variability in FTR rates across EGS services in Canada, which suggests that there is opportunity for ongoing quality-improvement efforts. This study provides FTR benchmarking data for Canadian EGS services. Contexte : On a propose que le risque de deces apres une complication postoperatoire--appele << echec de sauvetage >>--pourrait s'averer une mesure plus pertinente de la qualite du systeme de sante que les indicateurs comparatifs traditionnels, comme les taux de complications et de mortalite. Cette etude visait a determiner le taux reel d'echec de sauvetage dans les centres de chirurgies generales d'urgence (CGU) au Canada. Notre hypothese etait que ce taux varie grandement d'un centre a l'autre. Methodes : Dans le cadre de cette etude de cohorte retrospective multicentrique, nous avons realise une analyse secondaire des donnees issues d'une etude anterieure, dont l'objectif etait d'evaluer les interventions chirurgicales relatives a des atteintes ne touchant ni l'appendice ni la vesicule biliaire effectuees par 6 centres de CGU au Canada (1 en Colombie-Britannique, 1 en Alberta, 3 en Ontario et 1 en Nouvelle-Ecosse). Ces interventions ont eu lieu du 1er janvier au 31 decembre 2014. Nous avons compare les 2 categories de patients--avec complications et sans complications--au moyen d'analyses univariees. Nous avons aussi mene une analyse de sensibilite con-cernant le taux de mortalite apres des complications graves (3 ou 4 selon la classification de Clavien-Dindo) qui ont necessite une intervention chirurgicale ou des soins specialises (par exemple, une admission en soins intensifs). Resultats : L'etude a porte sur un total de 2595 patients. Sur les 206 patients decedes dans les 30 jours, 145 (70,4 %) ont eu une complication avant leur deces. Globalement, le taux de mortalite apres une complication postoperatoire (soit le taux d'echec de sauvetage) etait de 16,0 %. Le classement des centres avec les indicateurs traditionnels (taux de complications et de mortalite) n'etait pas le meme une fois pris en compte le taux d'echec de sauvetage. Conclusion : Le taux d'echec de sauvetage varie d'un centre de CGU a l'autre au pays, ce qui laisse croire qu'une amelioration continue de la qualite reste possible. Cette etude fournit des donnees de reference sur les taux d'echec de sauvetage aux centres de CGU au Canada., Emergency general surgery (EGS) conditions present a substantial health care burden, accounting for 7% of all hospital admissions in the United States. (1) About 25% of patients admitted with an [...]

Background: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. Methods: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged > 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. Results: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11 %) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and debridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall in-hospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). Conclusion: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement. Contexte : La plupart des etudes sur les services de chirurgie generate d'urgence (CGU) s'interessent seulement aux atteintes de l'appendice et de la vesicule biliaire. Pourtant, les chirurgiens du domaine traitent beaucoup d'autres problemes complexes. L'objectif de Petude etait de decrire le travail chirurgical associe a ces problemes dans l'ensemble du Canada. Methodes : Notre etude de cohorte retrospective multicentrique inclut les patients adultes ([greater than or equal to] 18 ans) qui ont subi en 2014 une operation non planifiee pour une atteinte qui ne touchait ni l'appendice ni la vesicule biliaire dans 1 des 7 centres selectionnes, repartis un peu part out au pays. Nous avons recueilli les donnees suivantes : renseignements de base des patients, diagnostic, details de l'intervention, nature des complications et duree d'hospitalisation. Puis nous avons degage les facteurs predictifs de morbidite et de mortalite en appliquant un modele de regression logistique. Resultats : L'echantillon totalisait 2595 patients, pour un age median de 60 ans (ecart interquartile 46-73 ans). Les diagnostics principaux les plus courants etaient l'occlusion de l'intestin grele (16%), la hernie (15 %), la tumeur maligne (11 %) et les lesions perianales (9%). Les interventions les plus frequentes etaient la resection de l'intestin (30%), la reparation d'une hernie (15%), le debridement (11 %) et le debridement de tissus mous ou cutanes infectes (10 %). L'operation a eu lieu le soir ou la nuit (entre 17 h et 8 h) dans 47 % des cas. Le taux global de mortalite a l'hopital etait de 8 %. Des complications sont survenues chez 33% des patients, dont les facteurs predictifs independants etaient Page avance (p = 0,001), un score ASA (de l'American Society of Anesthesiologists) eleve (p = 0,02) et le transfert a partir d'un autre centre (p = 0,001). Conclusion : Cette etude dresse le profil epidemiologique des interventions effectuees par les services de CGU du Canada en presence d'atteintes autres que celles de l'appendice et de la vesicule biliaire. Les chirurgiens du pays font beaucoup d'interventions generates urgent es, pour traiter des affections associees a un risque eleve de morbidite et de mortalite. Les resultats de Petude guideront les prochaines recherches et serviront de points de reference en matiere d'amelioration de la qualite., Emergency general surgery (EGS) is associated with a tremendous burden of disease. In the United States, EGS admissions represent 7% of all hospital admissions, and in 2010 they cost the [...]

The study aims to evaluate the efficacy of out-of-hospital hypertonic resuscitation in improving neurological outcomes following severe traumatic brain injury (TBI). The results indicate that such form of resuscitation did not result in any improved neurological outcomes in the case of patients with severe TBI.