Comparative analysis of emergency general surgery on‐call structure and its impact on emergency appendicectomy outcomes

2021 ◽  
Author(s):  
Jaya Gounder ◽  
Bhanuka Dissanayake ◽  
Matthew J. Burstow ◽  
Peter J. Yuide ◽  
Sanjeev Naidu ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
General Surgery ◽  
Emergency General Surgery ◽  
Call Structure

scholarly journals Does declared surgeon specialist interest influence the outcome of emergency laparotomy?

2020 ◽  
Vol 102 (6) ◽  
pp. 437-441
Author(s):  
S Hallam ◽  
M Bickley ◽  
L Phelan ◽  
M Dilworth ◽  
DM Bowley
Keyword(s):  
Length Of Stay ◽  
General Surgery ◽  
Special Interest ◽  
Operative Procedure ◽  
Emergency Laparotomy ◽  
Emergency General Surgery ◽  
Call Structure ◽  
Increased Risk ◽  
The Uk ◽  
National Emergency

Introduction In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. Methods Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. Results Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10–5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. Conclusion Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.

Appraising the Quality of Reporting of American College of Surgeons NSQIP Emergency General Surgery Studies

2021 ◽  
Vol 232 (5) ◽  
pp. 671-680 ◽  
Author(s):  
Mohamad El Moheb ◽  
Hadi Sabbagh ◽  
Daniel Badin ◽  
Tala Mahmoud ◽  
Basil Karam ◽  
...  
Keyword(s):  
General Surgery ◽  
Emergency General Surgery ◽  
Quality Of Reporting ◽  
American College Of Surgeons

scholarly journals 892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Hashmi ◽  
S Khalid ◽  
K Raja ◽  
A Zaka ◽  
J Easterbrook
Keyword(s):  
Informed Consent ◽  
Royal College ◽  
Mortality Risk ◽  
General Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Surgical Practice ◽  
Full Compliance ◽  
Type Of Surgery

Abstract Introduction COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic. Method Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined. Results Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02). Conclusions RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

The Obesity Paradox in Emergency General Surgery Patients

2021 ◽  
pp. 000313482096852
Author(s):  
Sean R. Maloney ◽  
Caroline E. Reinke ◽  
Abdelrahman A. Nimeri ◽  
Sullivan A. Ayuso ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
General Surgery ◽  
Multivariable Analysis ◽  
Operative Management ◽  
Chronic Obstructive ◽  
High Morbidity ◽  
Emergency General Surgery ◽  
Common Procedure ◽  
Increased Risk ◽  
Social Security Death Index ◽  
The Impact

Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2 and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates. A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed. A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9). When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.

Emergency General Surgery in the Elderly: Too Old or Too Frail?

2014 ◽  
Vol 219 (3) ◽  
pp. S53-S54 ◽  
Author(s):  
Bellal Joseph ◽  
Viraj Pandit ◽  
Bardiya Zangbar ◽  
Narong Kulvatunyou ◽  
Andrew L. Tang ◽  
...  
Keyword(s):  
General Surgery ◽  
The Elderly ◽  
Emergency General Surgery ◽  
Surgery In The Elderly

Emergency General Surgery in Older Patients: A National Comparison of Presentation and Outcomes

2014 ◽  
Vol 219 (3) ◽  
pp. S52-S53
Author(s):  
Syed Nabeel Zafar ◽  
Adil A. Shah ◽  
Zain G. Hashmi ◽  
Aftab Iqbal ◽  
Wendy R. Greene ◽  
...  
Keyword(s):  
General Surgery ◽  
Older Patients ◽  
Emergency General Surgery ◽  
National Comparison
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