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Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients.
Coimbra, Raul; Kim, Maru; Allison-Aipa, Timothy; Zakhary, Bishoy; Kwon, Junsik; Firek, Matthew; Coimbra, Bruno Cammarota; Costantini, Todd W; Haynes, Laura N; Edwards, Sara B.
Affiliation
  • Coimbra R; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Kim M; Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA.
  • Allison-Aipa T; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Zakhary B; Department of Trauma Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
  • Kwon J; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Firek M; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Coimbra BC; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Costantini TW; Department of Trauma Surgery, Ajou University School of Medicine, Seoul, Republic of Korea.
  • Haynes LN; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
  • Edwards SB; Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Am Surg ; 90(10): 2447-2456, 2024 Oct.
Article in En | MEDLINE | ID: mdl-38656140
ABSTRACT

INTRODUCTION:

We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR.

METHODS:

A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression.

RESULTS:

Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR.

DISCUSSION:

Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Readmission / Postoperative Complications / Failure to Rescue, Health Care Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Am Surg Year: 2024 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Readmission / Postoperative Complications / Failure to Rescue, Health Care Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: Am Surg Year: 2024 Document type: Article Affiliation country: Country of publication: