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

Authors :
Villodre C
Taccogna L
Zapater P
Cantó M
Mena L
Ramia JM
Lluís F
Afonso N
Aguilella V
Aguiló J
Alados JC
Alberich M
Apio AB
Balongo R
Bra E
Bravo-Gutiérrez A
Briceño FJ
Cabañas J
Cánovas G
Caravaca I
Carbonell S
Carrera-Dacosta E
Castro EE
Caula C
Choolani-Bhojwani E
Codina A
Corral S
Cuenca C
Curbelo-Peña Y
Delgado-Morales MM
Delgado-Plasencia L
Doménech E
Estévez AM
Feria AM
Gascón-Domínguez MA
Gianchandani R
González C
Hevia RJ
González MA
Hidalgo JM
Lainez M
Lluís N
López F
López-Fernández J
López-Ruíz JA
Lora-Cumplido P
Madrazo Z
Marchena J
de la Cuadra MB
Martín S
Casas MI
Martínez P
Mena-Mateos A
Morales-García D
Mulas C
Muñoz-Forner E
Naranjo A
Navarro-Sánchez A
Oliver I
Ortega I
Ortega-Higueruelo R
Ortega-Ruiz S
Osorio J
Padín MH
Pamies JJ
Paredes M
Pareja-Ciuró F
Parra J
Pérez-Guarinós CV
Pérez-Saborido B
Pintor-Tortolero J
Plua-Muñiz K
Rey M
Rodríguez I
Ruiz C
Ruíz R
Ruiz S
Sánchez A
Sánchez D
Sánchez R
Sánchez-Cabezudo F
Sánchez-Santos R
Santos J
Serrano-Paz MP
Soria-Aledo V
Tallón-Aguilar L
Valdivia-Risco JH
Vallverdú-Cartié H
Varela C
Villar-Del-Moral J
Zambudio N
Source :
International journal of surgery (London, England) [Int J Surg] 2022 Jan; Vol. 97, pp. 106168. Date of Electronic Publication: 2021 Nov 14.
Publication Year :
2022

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.<br />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.<br />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.<br />Conclusions: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.<br /> (Copyright © 2021 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1743-9159
Volume :
97
Database :
MEDLINE
Journal :
International journal of surgery (London, England)
Publication Type :
Academic Journal
Accession number :
34785344
Full Text :
https://doi.org/10.1016/j.ijsu.2021.106168