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Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study

2021; Wolters Kluwer; Volume: 97; Linguagem: Inglês

10.1016/j.ijsu.2021.106168

1743-9191

C. Villodre, L. Taccogna, Pedro Zapater, M. Cantó, Luís Mena, José Manuel Ramia, Fèlix Lluı́s, Nuno Afonso, V. Aguilella, Javier Aguiló, Juan Carlos Alados, M. Alberich, Ana Belén Apio, R. Balongo, E. Bra, Alberto Bravo-Gutiérrez, F. J. Briceño, J. Cabañas, Gloria Cánovas, I. Caravaca, Silvia Carbonell Morote, E. Carrera-Dacosta, Edgar Castro, Cèlia Caula, E. Choolani-Bhojwani, Antonio Daponte, S. Corral, C. Cuenca, Yuhamy Curbelo-Peña, M. M. Delgado-Morales, Luciano Delgado-Plasencia, E. Doménech, Andrea Medina Estévez, Alfredo Feria, M. A. Gascón-Domínguez, Rajesh Gianchandani Moorjani, C. González, R. Hevia, M. A. González, Juan Manuel Sánchez‐Hidalgo, Miguel J. A. Láinez, Núria Lluís, Fernando García López, José López‐Fernández, José Antonio López-Ruiz, P Lora-Cumplido, Zoilo Madrazo González, Joaquín Marchena Gómez, Marenco B. de la Cuadra, Shanique Martin, Martínez I. Casas, Pablo Martínez, A. Mena-Mateos, Dieter Morales-García, Claudia Mulas, E. Muñoz-Forner, Antonio Naranjo, Antonio Navarro‐Sánchez, Isabel Oliver, Irene Ortega, R. Ortega-Higueruelo, S. Ortega-Ruiz, Javier Osorio, M. H. Padín, José Pamies, María Celeste Gonzales Paredes, Felipe Pareja‐Ciuro, J. Parra, Carmen Victoria Pérez-Guarinos, B. Pérez-Saborido, José Pintor‐Tortolero, K.T. Plua-Muniz, M. Rey, Ingrid Rodrı́guez, Cristina Ballesteros Ruiz, R Caiña Ruiz, Sheila Picorelli Ruiz, Antonio Sánchez-Porto, David Sánchez‐Infantes, Rosa María Sánchez Pérez, F. Sánchez-Cabezudo, Raquel Sánchez‐Santos, Julio Pascual Santos, Pilar Serrano, Víctor Soria‐Aledo, Luis Tallón‐Aguilar, J. H. Valdivia-Risco, H. Vallverdú-Cartié, Carlos Federico Varela, Jesús Villar, Natalia Zambudio,

Abdominal Trauma and Injuries

Background and aims Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. Methods Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. Results A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101–500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500–1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. Conclusions This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement. Highlights The best benchmark cut-offs in Emergency General Surgery are unknown. The present study established benchmark cut-off values in a low-risk cohort. Benchmark cut-off was ≥40.9% for use of laparoscopy, and ≤3 days for hospital stays. Benchmark cut-off was ≤17.7% for 30-day morbidity, and ≤1.1% for 30-day mortality. These cut-offs values may guide quality improvement in Emergency General Surgery.