Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. (January 2022)

• Record Type: Journal Article
• Authors: Villodre, C.; Taccogna, L.; Zapater, P.; Cantó, M.; Mena, L.; Ramia, J.M.; Lluís, F.; Afonso, N.; Aguilella, V.; Aguiló, J.; Alados, J.C.; Alberich, M.; Apio, A.B.; Balongo, R.; Bra, E.; Bravo-Gutiérrez, A.; Briceño, F.J.; Cabañas, J.; Cánovas, G.; Caravaca, I.; Carbonell, S.; Carrera-Dacosta, E.; Castro E, E.; Caula, C.; Choolani-Bhojwani, E.; Codina, A.; Corral, S.; Cuenca, C.; Curbelo-Peña, Y.; Delgado-Morales, M.M.; Delgado-Plasencia, L.; Doménech, E.; Estévez, A.M.; Feria, A.M.; Gascón-Domínguez, M.A.; Gianchandani, R.; González, C.; Hevia, R.J.; González, M.A.; Hidalgo, J.M.; Lainez, M.; Lluís, N.; López, F.; López-Fernández, J.; López-Ruíz, J.A.; Lora-Cumplido, P.; Madrazo, Z.; Marchena, J.; Marenco de la Cuadra, B.; Martín, S.; Casas, I. Martínez; Martínez, P.; Mena-Mateos, A.; Morales-García, D.; Mulas, C.; Muñoz-Forner, E.; Naranjo, A.; Navarro-Sánchez, A.; Oliver, I.; Ortega, I.; Ortega-Higueruelo, R.; Ortega-Ruiz, S.; Osorio, J.; Padín, M.H.; Pamies, J.J.; Paredes, M.; Pareja-Ciuró, F.; Parra, J.; Pérez-Guarinós, C.V.; Pérez-Saborido, B.; Pintor-Tortolero, J.; Plua-Muñiz, K.; Rey, M.; Rodríguez, I.; Ruiz, C.; Ruíz, R.; Ruiz, S.; Sánchez, A.; Sánchez, D.; Sánchez, R.; Sánchez-Cabezudo, F.; Sánchez-Santos, R.; Santos, J.; Serrano-Paz, M.P.; Soria-Aledo, V.; Tallón-Aguilar, L.; Valdivia-Risco, J.H.; Vallverdú-Cartié, H.; Varela, C.; Villar-del-Moral, J.; Zambudio, N.;
• Is Part Of: International journal of surgery. Volume 97(2022)
• Publication Date: 2022-01
• Subjects: Risk-prediction -- Benchmarking -- Quality improvement -- Emergency general surgery; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2021.106168
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: 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.