Recurring emergency general surgery: Characterizing a vulnerable population

Nicole Lunardi, Ambar Mehta, Hiba Ezzeddine, Joseph K. Canner, Mohammad Hamidi, Faisal Jehan, Bellal A. Joseph, Avery B. Nathens, David T. Efron, Jose Diaz, Joseph V. Sakran

Research output: Contribution to journalArticle

Abstract

BACKGROUND Limited data exist for long-term outcomes after emergency general surgeries (EGSs) in the United States. This study aimed to characterize the incidence of inpatient readmissions and additional operations within 6 months of an EGS procedure. METHODS In this retrospective observational study, we identified adults (≥18 years old) undergoing one of seven common EGS procedures (appendectomies, cholecystectomies, small bowel resections, large bowel resections, control of gastrointestinal [GI] ulcers and bleeding, peritoneal adhesiolysis, and exploratory laparotomies) who were discharged alive in the 2010-2015 National Readmissions Database. Outcomes included the rates of all-cause inpatient readmissions and of undergoing a second EGS procedure, both within 6 months. Multivariable logistic regression models identified risk factors of reoperation, adjusting for patient, clinical, and hospital factors. RESULTS Of 706,678 patients undergoing an EGS procedure 131,291 (18.6%) had an inpatient readmission within 6 months. Among those readmitted, 15,178 (11.6%) underwent a second EGS procedure, occurring at a median of 45 days (interquartile range, 15-95). After adjustment, notable predictors of reoperation included male sex (adjusted odds ratio [aOR], 1.06 [95% confidence interval, 1.01-1.10]); private, nonprofit hospitals (aOR, 1.09 [1.02-1.17]); private, investor-owned hospitals (aOR, 1.09 [1.00-1.85]); discharge to short-term hospital (aOR, 1.35 [1.04-1.74]); discharge with home health care (aOR, 1.19 [1.13-1.25]); and index procedure of control of GI ulcer and bleeding (aOR, 9.38 [8.75-10.05]), laparotomy (aOR, 7.62 [6.92-8.40]), or large bowel resection (aOR, 6.94 [6.44-7.47]). CONCLUSION One fifth of patients undergoing an EGS procedure had an inpatient readmission within 6 months, where one in nine of those underwent a second EGS procedure. As half of all second EGS procedures occurred within 6 weeks of the index procedure, identifying patients with the highest health care needs (index procedure type and discharge needs) may identify patients at risk for subsequent reoperation in nonemergency settings. LEVEL OF EVIDENCE Epidemiological, level III.

Original languageEnglish (US)
Pages (from-to)464-470
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number3
DOIs
StatePublished - Mar 1 2019

Keywords

  • Emergency general surgery
  • outcomes
  • readmissions
  • recurring operation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Recurring emergency general surgery: Characterizing a vulnerable population'. Together they form a unique fingerprint.

  • Cite this

    Lunardi, N., Mehta, A., Ezzeddine, H., Canner, J. K., Hamidi, M., Jehan, F., Joseph, B. A., Nathens, A. B., Efron, D. T., Diaz, J., & Sakran, J. V. (2019). Recurring emergency general surgery: Characterizing a vulnerable population. Journal of Trauma and Acute Care Surgery, 86(3), 464-470. https://doi.org/10.1097/TA.0000000000002151