Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery

George Ramsay (Corresponding Author), Jared M. Wohlgemut, Jan O. Jansen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development. METHODS This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included. RESULTS There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate. CONCLUSIONS Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.

Original languageEnglish
Pages (from-to)500-506
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number3
Early online date17 Jul 2018
DOIs
Publication statusPublished - 30 Sep 2018
EventASGBI 2018 International Surgical Congress - Liverpool, United Kingdom
Duration: 9 May 201811 May 2018

Fingerprint

Emergencies
National Health Programs
Scotland
Cholecystitis
Mortality
United Kingdom
Diagnosis-Related Groups
Appendicitis
Constipation
Workload
Pancreatitis
Abdominal Pain
Endoscopy
Comorbidity
Drainage
Length of Stay
Patient Care
Skin
Health
Population

Keywords

  • diagnosis
  • Emergency general surgery
  • operations

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{b8778b6ccf4945cba4fa3e5955be748b,
title = "Emergency general surgery in the United Kingdom: A lot of general, not many emergencies, and not much surgery",
abstract = "BACKGROUND The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development. METHODS This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included. RESULTS There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55{\%} vs 45{\%}, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2{\%}), cholecystitis (7.2{\%}), constipation (3.4{\%}), pancreatitis (3.1{\%}), diverticular disease (3.1{\%}), and appendicitis (3.1{\%}). Only 25{\%} of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1{\%}), endoscopy (11.3{\%}), and drainage of skin lesions (9.7{\%}). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8{\%} mortality rate. CONCLUSIONS Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.",
keywords = "diagnosis, Emergency general surgery, operations",
author = "George Ramsay and Wohlgemut, {Jared M.} and Jansen, {Jan O.}",
note = "We are grateful to Ms Lizzie Nicholson, Senior Information Analyst at the Information Services Division of the NHS in Scotland, for extracting and transferring the data. In addition, the authors thank the Data Safe Haven team at the University of Aberdeen for storing and providing access to the data, and technical support. The authors also thank Dr Neil Scott (statistician, University of Aberdeen) for his advice regarding statistical analysis.",
year = "2018",
month = "9",
day = "30",
doi = "10.1097/TA.0000000000002010",
language = "English",
volume = "85",
pages = "500--506",
journal = "The journal of trauma and acute care surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Emergency general surgery in the United Kingdom

T2 - A lot of general, not many emergencies, and not much surgery

AU - Ramsay, George

AU - Wohlgemut, Jared M.

AU - Jansen, Jan O.

N1 - We are grateful to Ms Lizzie Nicholson, Senior Information Analyst at the Information Services Division of the NHS in Scotland, for extracting and transferring the data. In addition, the authors thank the Data Safe Haven team at the University of Aberdeen for storing and providing access to the data, and technical support. The authors also thank Dr Neil Scott (statistician, University of Aberdeen) for his advice regarding statistical analysis.

PY - 2018/9/30

Y1 - 2018/9/30

N2 - BACKGROUND The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development. METHODS This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included. RESULTS There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate. CONCLUSIONS Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.

AB - BACKGROUND The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, to facilitate comparisons and future service development. METHODS This is a cross-sectional population-based study based in the National Health Service in Scotland, one of the home nations of the United Kingdom. All patients aged 16 or older admitted under the care of a general surgeon, as an emergency, to a National Health Service hospital in Scotland, in 2016, were included. RESULTS There were 81,446 emergency general surgery admissions by 66,498 patients. Median episode age was 53 years. There were more female patients than male (55% vs 45%, p < 0.0001). The most common diagnoses were nonspecific abdominal pain (20.2%), cholecystitis (7.2%), constipation (3.4%), pancreatitis (3.1%), diverticular disease (3.1%), and appendicitis (3.1%). Only 25% of patients had operations (n = 20,292). The most frequent procedures were appendicectomy (13.1%), endoscopy (11.3%), and drainage of skin lesions (9.7%). Diagnoses and operations differed with age. Overall median length of stay was 1 day. With a 6-month follow-up, patients older than 75 years had a 19.8% mortality rate. CONCLUSIONS Emergency general surgery in the United Kingdom is a high-volume, diagnostically diverse, and low-operative volume specialty with high short-term mortality rate in elderly patients. Consideration should be given to alternative service delivery models, which make better use of surgeons' skills while also ensuring optimal care for patients who are increasingly elderly and have complex chronic health problems.

KW - diagnosis

KW - Emergency general surgery

KW - operations

UR - http://www.scopus.com/inward/record.url?scp=85052759506&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002010

DO - 10.1097/TA.0000000000002010

M3 - Article

VL - 85

SP - 500

EP - 506

JO - The journal of trauma and acute care surgery

JF - The journal of trauma and acute care surgery

SN - 2163-0755

IS - 3

ER -