A. A. Shah1,6, H. Zafar6, R. Riviello3, C. K. Zogg1, M. S. Halim7, S. Zafar5, A. Latif8, Z. Rehman6, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 3Harvard School Of Medicine,Center For Surgery And Public Health, Brigham And Women’s Hospital,Brookline, MA, USA 5Howard University College Of Medicine,Department Of Surgery,Washington, DC, USA 6Aga Khan University Medical College,Department Of Surgery,Karachi, Sindh, Pakistan 7Aga Khan University Medical College,Section Of Critical Care, Department Of Medicine,Karachi, Sindh, Pakistan 8Johns Hopkins University School Of Medicine,Department Of Anesthesia,Baltimore, MD, USA
Introduction: The field of emergency general surgery (EGS) has rapidly evolved as a distinct component of acute care surgery. However, nuanced understandings of outcome predictors in EGS have been slow to emerge, particularly in resource-constrained parts of the world. The objective of this study was to describe the disease spectrum and risk factors associated with outcomes of EGS among patients presenting to a tertiary care facility in Pakistan.
Methods: Discharge data from a university hospital were obtained for all adult patients (≥16 years) presenting between March 2009 and April 2014 with ICD-9-CM diagnosis codes consistent with an EGS condition, as described by the American Association for the Surgery of Trauma (AAST). Multivariate analyses, accounting for age, gender, year of admission, type of admission, admitting specialty, length of stay (LOS), major complications and Charlson Comorbidity Index, were used to assess potential associations between demographic/clinical factors and all-cause mortality and major complications (pneumonia, pulmonary emboli, urinary tract infections, cerebrovascular accidents, myocardial infarcts, cardiac arrest and systemic sepsis).
Results: Records for 13,893 patients were identified. Average age was 47.2 (±16.8) years, with a male preponderance (59.9%). The majority of patients presented with an admitting diagnosis of biliary disease (20.2%) followed by soft tissue disorders (15.7%), hernias (14.9%) and colorectal disease (14.3%). The crude rates of death and complications were 2.7% and 6.6%, respectively. Increasing age was an independent predictor of death and complications. Patients admitted for resuscitation (n=225) had the highest likelihood of mortality and complications (OR [95% CI]: 229.0 [169.8-308.8], 421.0 [244.8-724.3], respectively). The median length of hospital stay was 2 (IQR: 1-5) days. Examination of the proportion of deaths over a 30-day LOS revealed a tri-modal mortality distribution that peaked on days 20, 25 and 30.
Conclusion: Patients of advanced age and those requiring resuscitation are at greater risk of both mortality and complications. This study provides an important first step toward quantifying the burden of EGS conditions in a lower-middle-income country. Data presented here will help facilitate efforts to benchmark EGS in similar and, as yet, unexplored settings.
