Recurring Emergency General Surgery: Characterizing a Vulnerable Population

Introduction Limited data exists for long-term outcomes after emergency general surgeries (EGS) in the United States. This study aimed to characterize the incidence of inpatient readmissions and additional operations within 6-months of an EGS procedure. Methods In this retrospective observational study, we identified adults (≥18 years old) undergoing one of seven common EGS procedures (appendectomies, cholecystectomies, small bowel resections, large bowel resections, control of GI ulcers and bleeding, peritoneal adhesiolysis, and exploratory laparotomies) who were discharged alive in the 2010-2015 National Readmissions Database. Outcomes included the rates of all-cause inpatient readmissions and of undergoing a second EGS procedure, both within 6-months. Multivariable logistic regression models identified risk-factors of re-operation, adjusting for patient, clinical, and hospital factors. Results Of 706,678 patients undergoing an EGS procedure (35.8% control of GI ulcer and bleeding, 25.0% peritoneal adhesiolysis), 131,291 (18.6%) had an inpatient readmission within 6-months. Among those readmitted, 15,178 (11.6%) underwent a second EGS procedure, occurring at a median of 45 days (IQR: 15-95). After adjustment, notable predictors of re-operation included: male gender (adjusted odds ratio [aOR] 1.06 [95%-CI: 1.01-1.10]), private, non-profit hospitals (aOR 1.09 [1.02-1.17]), private, investor-owned hospitals (aOR 1.09 [1.00-1.85]), discharge to short-term hospital (aOR 1.35 [1.04-1.74]), discharge with home health care (aOR 1.19 [1.13-1.25]), and index procedure of control of GI ulcer and bleeding (aOR 9.38 [8.75-10.05]), laparotomy (aOR 7.62 [6.92-8.40]), or large bowel resection (aOR 6.94 [6.44-7.47]). Conclusion One-fifth of patients undergoing an EGS procedure had an inpatient readmission within 6-months, where one-in-nine of those underwent a second EGS procedure. As half of all second EGS procedures occurred within six weeks of the index procedure, identifying patients with the highest health care needs (index procedure type and discharge needs) may identify patients at risk for subsequent re-operation in non-emergency settings. Level of Evidence Level 3, Epidemiological Corresponding author: Joseph V. Sakran, MD, MPH, MPA, Department of Surgery, Division of Acute Care Surgery, Sheikh Zayed Tower, Suite 6107, Baltimore, MD 21287. Tel: 410-955-2244. Fax: 410-955-1884. Email: jsakran1@jhmi.edu Poster Presentation: 77th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery, September 26-29, 2018 in San Diego, CA Disclosures: None. © 2018 Lippincott Williams & Wilkins, Inc.

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