Seven Procedures Identified as Riskiest Emergency Surgeries

Seven operations, including appendectomy and cholecystectomy, account for 80% of emergency general surgery (EGS) deaths in the United States, according to a new study.

Researchers at Brigham and Women's Hospital (Boston, AM, USA) conducted a retrospective review study using data from the 2008-2011 U.S. National Inpatient Sample to define which surgical procedures account for the majority of the national burden of operative EGS. Participants included 421,476 adults admitted urgently who underwent an operative procedure within two days of admission. Among the ranked procedures, contributions to total EGS frequency, mortality, and hospital costs were assessed.

After ranking the 35 procedure groups by contribution to EGS mortality and morbidity burden, a final set of seven operative EGS procedures were identified which collectively accounted for 80% of procedures, 80.3% of deaths, 78.9% of complications, and 80.2% of inpatient costs. The seven procedures included partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy, and laparotomy. The overall mortality rate was 1.23%, complication rate was 15%, and the mean cost per admission was USD 13,241. The study was published on April 27, 2016, in JAMA Surgery.

“Emergency general surgery is inherently more risky because it is performed with little to no advance planning or preparation, on patients who are in dire straits. They typically are suffering from gastrointestinal bleeding, a bowel obstruction, or severe infections of the digestive tract,” said senior author Joaquim Havens, MD. “Our gastrointestinal tract is just so specialized and so critical to our existence; we think it's easy to operate on, but then in practice it's very difficult for patients. We find that even patients who undergo open heart surgery can have better outcomes than patients that undergo open intestinal surgery.”

“Some of the top seven operations are simply very risky, particularly when performed on an emergency basis,” said Martin Paul, MD, regional director of minimally invasive surgery for Johns Hopkins (Washington, DC, USA), in an accompanying editorial. “Bowel resection is probably, even as an elective procedure, considered a risky operation. To do that under emergency circumstances when you don't have the benefit of a bowel that's been cleansed ahead of time, it sets the stage for some serious and expensive complications.”

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