Abstract
Introduction
Emergency general surgery among cardiac surgery patients is increasingly common and
consequential. We sought to characterize the true burden of emergency general surgery
among hospitalized complex cardiac patients.
Methods
We performed a retrospective analysis of the 2016-2017 National Inpatient Sample.
We included adult patients with a primary diagnosis of complex cardiac disease. We
then compared patients who underwent emergency general surgery (GS-OR) with those
who did not (non–GS-OR). The primary outcome was mortality; secondary outcomes included
length of stay and hospitalization costs.
Results
We identified 10.2 million patients with a primary diagnosis of complex cardiac disease,
of which 148,309 (1.4%) underwent GS-OR. Mortality rates were significantly higher
in the GS-OR group (11.0% versus 5.0%, P < 0.001). Among all cardiac patients, GS-OR was associated with 2.2 times increased
odds of death (aOR: 2.2, P < 0.001). GS-OR patients also had longer length of stays (14.1 versus 5.8 d, P < 0.001). Among all cardiac patients, GS-OR was associated with an 8.1-day longer
length of stay (P < 0.001). GS-OR patients were less often routinely discharged home (31.7% versus 45.3%, P < 0.001) and incurred higher inpatient costs ($46,136 versus $16,303, P < 0.001). Among all cardiac patients, GS-OR patients incurred $30,102 higher hospitalization
costs (P < 0.001).
Conclusions
Emergency general surgery among cardiac surgery patients is associated with a greater
than two-fold increase in mortality, longer length of stays, higher rates of nonroutine
discharge, and higher hospitalization costs. Emergency general surgery complications
account for 4.0% of total inpatient costs of cardiac surgery patients and merit further
study.
Keywords
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References
- 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European society of cardiology (ESC) and the European society of anaesthesiology (ESA).Eur J Anaesthesiol. 2014; 31: 517-573
- The public health burden of emergency general surgery in the United States: a 10-year analysis of the Nationwide Inpatient Sample—2001 to 2010.J Trauma Acute Care Surg. 2014; 77: 202-208
- The future of emergency general surgery.Ann Surg. 2019; 270: 221-222
- The excess morbidity and mortality of emergency general surgery.J Trauma Acute Care Surg. 2015; 78: 306-311
- Predictors of gastrointestinal complications in cardiac surgery.Tex Heart Inst J. 2000; 27: 93-99
- Incidence and outcome of gastrointestinal complications after cardiopulmonary bypass.Interact Cardiovasc Thorac Surg. 2006; 5: 239-242
- Gastrointestinal complications after cardiothoracic surgery.Eur J Cardiothorac Surg. 1996; 10: 763-767
- Gastrointestinal complications in 4473 patients who underwent cardiopulmonary bypass surgery.Br J Surg. 1991; 78: 293-296
- Gastrointestinal complications following cardiac surgery.Cardiovasc Surg. 1995; 3: 341-344
- Gastrointestinal complications after coronary artery bypass grafting: a national study of morbidity and mortality predictors.J Am Coll Surg. 2007; 205: 741-747
- Predictors and outcomes of gastrointestinal complications in patients undergoing coronary artery bypass graft surgery: a prospective, nested case-control study.J Am Coll Surg. 2004; 198: 742-747
- Gastrointestinal complications following cardiac surgery: an analysis of 1477 cardiac surgery patients.Arch Surg. 1997; 132: 352-357
- Hospital inpatient quality reporting program measures international classification of diseases, 10th edition, clinical modification System (ICD-10-CM) DRAFT code sets.(Available at:)
- National Healthcare Safety Network (NHSN) patient safety component manual.(Available at:)https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdfDate: 2021Date accessed: September 10, 2020
- Outcomes after surgery among patients diagnosed with one or more multi-drug-resistant organisms.Surg Infect (Larchmt). 2021; 22: 722-729
- ICD-10-PCS reference manual.(Available at:)www.cms.gov/Medicare/coding/ICD10/2020-ICD-10-PCSDate accessed: September 10, 2020
- Cost-to-Charge Ratio Files.(Available at:)https://www.hcup-us.ahrq.gov/db/state/costtocharge.jspDate accessed: September 12, 2020
- Gastrointestinal complications in patients undergoing heart operation: an analysis of 8709 consecutive cardiac surgical patients.Ann Surg. 2005; 241: 895-901
- Abdominal operations after left ventricular assist device implantation and heart transplantation.J Surg Res. 2019; 243: 481-487
- When is death inevitable after emergency laparotomy? Analysis of the American College of surgeons national surgical quality improvement program database.J Am Coll Surg. 2012; 215: 503-511
- Improving outcomes in emergency general surgery patients: what evidence is out there?.Anesth Analg. 2017; 125: 1403-1405
- Diagnosis and outcome from suspected mesenteric ischaemia following cardiac surgery.Anesth Intensive Care. 2005; 33: 210-217
- Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience.Can J Gastroenterol. 2005; 19: 613-617
- Predictors and outcome of gastrointestinal complications in patients undergoing cardiac surgery.Ann Surg. 2007; 246: 323-329
- Clinically diagnosed nonocclusive mesenteric ischemia after cardiopulmonary bypass: retrospective study.Vascular. 2004; 12: 114-120
- Intestinal ischemia after cardiac surgery: analysis of a large registry.J Cardiothorac Surg. 2013; 8: 156
- The importance of improving the quality of emergency surgery for a regional quality collaborative.Ann Surg. 2013; 257: 596-602
- Differences in rural and urban outcomes: a national inspection of emergency general surgery patients.J Surg Res. 2017; 218: 277-284
- The economic footprint of acute care surgery in the United States: implications for systems development.J Trauma Acute Care Surg. 2019; 86: 609-616
Article info
Publication history
Published online: November 08, 2022
Accepted:
October 17,
2022
Received in revised form:
September 25,
2022
Received:
March 23,
2022
Footnotes
This research was presented as a quick shot presentation at the virtual 2021 Academic Surgical Congress in February 2021.
Identification
Copyright
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