Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals
Abstract Background In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perio...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12873-019-0241-6 |
| _version_ | 1819089880523735040 |
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| author | Félix R. Montes Skarlet Marcell Vásquez Claudia Marcela Camargo-Rojas Myriam V. Rueda Lina Góez-Mogollón Paula A. Alvarado Danny J. Novoa Juan Carlos Villar |
| author_facet | Félix R. Montes Skarlet Marcell Vásquez Claudia Marcela Camargo-Rojas Myriam V. Rueda Lina Góez-Mogollón Paula A. Alvarado Danny J. Novoa Juan Carlos Villar |
| author_sort | Félix R. Montes |
| collection | DOAJ |
| description | Abstract Background In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient’s risk categories. Methods A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. Results Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5–53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1–2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p < 0.001 for the interaction). Conclusion Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases. |
| first_indexed | 2024-12-21T22:14:58Z |
| format | Article |
| id | doaj.art-2e9311d6773a43a4b759024bf8481dcd |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-21T22:14:58Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-2e9311d6773a43a4b759024bf8481dcd2022-12-21T18:48:29ZengBMCBMC Emergency Medicine1471-227X2019-04-0119111010.1186/s12873-019-0241-6Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitalsFélix R. Montes0Skarlet Marcell Vásquez1Claudia Marcela Camargo-Rojas2Myriam V. Rueda3Lina Góez-Mogollón4Paula A. Alvarado5Danny J. Novoa6Juan Carlos Villar7Departamento de Anestesiología, Fundación CardioInfantil– Instituto de Cardiología and Universidad del RosarioGrupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de BucaramangaDepartamento de Investigaciones, Fundación CardioInfantil– Instituto de CardiologíaDepartamento de Medicina Interna, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga and Fundación Oftalmológica de Santander- Clínica FOSCALDepartamento de Investigaciones, Fundación CardioInfantil– Instituto de CardiologíaDepartamento de Investigaciones, Fundación CardioInfantil– Instituto de CardiologíaDepartamento de Medicina Interna, Fundación CardioInfantil– Instituto de Cardiología and Universidad del RosarioGrupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de BucaramangaAbstract Background In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient’s risk categories. Methods A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. Results Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5–53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1–2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p < 0.001 for the interaction). Conclusion Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases.http://link.springer.com/article/10.1186/s12873-019-0241-6Emergency surgeryEmergency departmentLength of stayOutcome |
| spellingShingle | Félix R. Montes Skarlet Marcell Vásquez Claudia Marcela Camargo-Rojas Myriam V. Rueda Lina Góez-Mogollón Paula A. Alvarado Danny J. Novoa Juan Carlos Villar Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals BMC Emergency Medicine Emergency surgery Emergency department Length of stay Outcome |
| title | Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals |
| title_full | Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals |
| title_fullStr | Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals |
| title_full_unstemmed | Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals |
| title_short | Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: a cohort study in two Colombian University hospitals |
| title_sort | association between emergency department length of stay and adverse perioperative outcomes in emergency surgery a cohort study in two colombian university hospitals |
| topic | Emergency surgery Emergency department Length of stay Outcome |
| url | http://link.springer.com/article/10.1186/s12873-019-0241-6 |
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