Association between surgical delay and survival in high-risk emergency abdominal surgery: A population-based Danish cohort study

TY - JOUR

T1 - Association between surgical delay and survival in high-risk emergency abdominal surgery

T2 - A population-based Danish cohort study

AU - Vester-Andersen, Morten

AU - Lundstrøm, Lars Hyldborg

AU - Buck, David Levarett

AU - Møller, Morten Hylander

PY - 2016/1/2

Y1 - 2016/1/2

N2 - OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general.MATERIAL AND METHODS: All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression.RESULTS: A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding.CONCLUSIONS: In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.

AB - OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general.MATERIAL AND METHODS: All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression.RESULTS: A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding.CONCLUSIONS: In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.

KW - Abdomen

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Denmark

KW - Emergencies

KW - Female

KW - Hospitalization

KW - Humans

KW - Laparoscopy

KW - Laparotomy

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Odds Ratio

KW - Outcome Assessment (Health Care)

KW - Registries

KW - Risk Factors

KW - Surgical Procedures, Operative

KW - Time Factors

KW - Journal Article

KW - Multicenter Study

U2 - 10.3109/00365521.2015.1066422

DO - 10.3109/00365521.2015.1066422

M3 - Journal article

C2 - 26153059

SN - 0085-5928

VL - 51

SP - 121

EP - 128

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 1

ER -