Twenty‐year study of in‐hospital and postdischarge mortality following emergency general surgical admission

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

Research output: Contribution to journalArticle

Abstract

Introduction EGS patients have higher mortality than elective surgical inpatients. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates post discharge. A comprehensive, population-based analysis of mortality rates in EGS patients, over a 20-year timeframe was therefore conducted. Methods This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson co-morbidity index and operations were coded by OPCS4 classifications. Linear and multivariate logistic regression models were used to evaluate changes over time. Results Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and one-year mortality rates were 1.8%, 3.8%, 6.4% and 12.5%, respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all p<0.0001) and improved with time on subgroup analysis by age, co-morbidity and operations. Medium-term mortality was high: The one-year mortality rate in patients >75 years was 35.6%. One-year mortality in highly co-morbid patients decreased from 75% to 57% over the timeframe of the study (p<0.0001). Conclusion EGS in Scotland has experienced a significant reduction in mortality over time. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates and, as such, post-discharge management is more than currently appreciated.
Original languageEnglish
JournalBJS Open
Early online date9 Jul 2019
DOIs
Publication statusE-pub ahead of print - 9 Jul 2019

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Hospital Mortality
Emergencies
Mortality
Scotland
Morbidity
Inpatients
Logistic Models
Cross-Sectional Studies

Cite this

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title = "Twenty‐year study of in‐hospital and postdischarge mortality following emergency general surgical admission",
abstract = "Introduction EGS patients have higher mortality than elective surgical inpatients. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates post discharge. A comprehensive, population-based analysis of mortality rates in EGS patients, over a 20-year timeframe was therefore conducted. Methods This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson co-morbidity index and operations were coded by OPCS4 classifications. Linear and multivariate logistic regression models were used to evaluate changes over time. Results Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and one-year mortality rates were 1.8{\%}, 3.8{\%}, 6.4{\%} and 12.5{\%}, respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all p<0.0001) and improved with time on subgroup analysis by age, co-morbidity and operations. Medium-term mortality was high: The one-year mortality rate in patients >75 years was 35.6{\%}. One-year mortality in highly co-morbid patients decreased from 75{\%} to 57{\%} over the timeframe of the study (p<0.0001). Conclusion EGS in Scotland has experienced a significant reduction in mortality over time. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates and, as such, post-discharge management is more than currently appreciated.",
author = "George Ramsay and Jared Wohlgemut and Jansen, {Jan O.}",
note = "We are grateful to Lizzie Nicholson, and the team at the Information Services Division, Scotland for their support in providing us with these data and the Data Safehaven Department of the University of Aberdeen for its storage. The authors would also like to thanks Dr Neil Scott and Dr Rute Vieira of the Department of Medical Statistics, University of Aberdeen for their advice in conducting this research.",
year = "2019",
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AU - Ramsay, George

AU - Wohlgemut, Jared

AU - Jansen, Jan O.

N1 - We are grateful to Lizzie Nicholson, and the team at the Information Services Division, Scotland for their support in providing us with these data and the Data Safehaven Department of the University of Aberdeen for its storage. The authors would also like to thanks Dr Neil Scott and Dr Rute Vieira of the Department of Medical Statistics, University of Aberdeen for their advice in conducting this research.

PY - 2019/7/9

Y1 - 2019/7/9

N2 - Introduction EGS patients have higher mortality than elective surgical inpatients. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates post discharge. A comprehensive, population-based analysis of mortality rates in EGS patients, over a 20-year timeframe was therefore conducted. Methods This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson co-morbidity index and operations were coded by OPCS4 classifications. Linear and multivariate logistic regression models were used to evaluate changes over time. Results Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and one-year mortality rates were 1.8%, 3.8%, 6.4% and 12.5%, respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all p<0.0001) and improved with time on subgroup analysis by age, co-morbidity and operations. Medium-term mortality was high: The one-year mortality rate in patients >75 years was 35.6%. One-year mortality in highly co-morbid patients decreased from 75% to 57% over the timeframe of the study (p<0.0001). Conclusion EGS in Scotland has experienced a significant reduction in mortality over time. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates and, as such, post-discharge management is more than currently appreciated.

AB - Introduction EGS patients have higher mortality than elective surgical inpatients. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates post discharge. A comprehensive, population-based analysis of mortality rates in EGS patients, over a 20-year timeframe was therefore conducted. Methods This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson co-morbidity index and operations were coded by OPCS4 classifications. Linear and multivariate logistic regression models were used to evaluate changes over time. Results Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and one-year mortality rates were 1.8%, 3.8%, 6.4% and 12.5%, respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all p<0.0001) and improved with time on subgroup analysis by age, co-morbidity and operations. Medium-term mortality was high: The one-year mortality rate in patients >75 years was 35.6%. One-year mortality in highly co-morbid patients decreased from 75% to 57% over the timeframe of the study (p<0.0001). Conclusion EGS in Scotland has experienced a significant reduction in mortality over time. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates and, as such, post-discharge management is more than currently appreciated.

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