K. Franklin1,2, A. McCracken1, M. Nishtala1,2, B. Zarzaur1,2 1University Of Wisconsin, School Of Medicine And Public Health, Madison, WI, USA 2University of Wisconsin Hospitals and Clinics, Department Of Surgery, Division Of Acute Care And Regional General Surgery, Madison, WI, USA
Introduction:
Prompt operative treatment of urgencies and emergencies is a cornerstone of high-quality surgical care. Increased time to the OR in emergency general surgery (EGS) patients has been identified as an independent risk factor for 30-day mortality in local samples1. Furthermore, the around-the-clock presence of emergency surgeons and operating room personnel has been associated with increased survival2. However, this care may not be equitably distributed. Counties with greater proportions of minority racial and economic groups are significantly less likely to have access to this dedicated EGS care3. A critical gap exists in our understanding of which factors influence operative timing and how this may contribute to disparate outcomes.
We hypothesize that among patients undergoing EGS procedures, those operated on early in their hospitalization will have a decreased likelihood of 30-day mortality and that members of racial minority groups would be less likely to receive this prompt care.
Methods:
We conducted an analysis of adult patients in the National Surgical Quality Improvement Program (NSQIP) from 2015-2022 whose procedure was classified as emergent. Patients were grouped by the day in which they received their operation, with days 0-2 designated as early intervention and days ≥3 designated as late intervention. We applied generalized linear mixed models using the GLIMMIX procedure to determine probability of early intervention and 30-day mortality, respectively. Our models included frailty (mFI-5), preoperative heath modifiers (such as smoking, dialysis, etc.), age, BMI, sex, and procedure type.
Results:
A total of 272,411 patients (mean age 47.1) were included in the analysis. Patients within the “late intervention” group (N = 37399) were older (mean age = 58.3) and were 47% of minority racial groups (including Black, Asian, and Native identities). Late intervention was associated with increased 30-day mortality (p<0.001), however, race was not (p=0.45). However, race was associated with likelihood of membership in the “late intervention group” (p<0.001).
Conclusion:
Time to operative intervention is demonstrated in a nationally-representative sample to increase the likelihood of 30-day mortality in EGS patients. Patients who belong to racial minority groups are less likely to undergo early intervention, suggesting that the distribution of emergency surgical care may not be equitable. However, race is not independently associated with increased mortality.
1. Wood, T. (2018). Effect of time to operation on outcomes in adults who underwent emergency general surgery procedure. Journal of Surgical Research, 228.
2. Daniel, V. T. (2019). Association between operating room access and mortality for life-threatening general surgery emergencies. Journal of Trauma and Acute Care Surgery, 87(1).
3. Khubchandani (2018). Disparities in access to emergency general surgery care in the United States. Surgery, 163(2).