Key result
Prolonged emergency department length of stay (>48 hours) increased the risk of adverse perioperative outcomes (adjusted OR 1.99), particularly for patients without mortality risk factors (OR 2.52).
Why the study?
In low- and middle-income countries emergency surgery accounts for more surgeries and higher morbidity/mortality, but whether emergency department length of stay relates to adverse perioperative outcomes across risk categories was unknown.
Does prolonged emergency department length of stay increase adverse perioperative outcomes in adult patients undergoing emergency orthopedic or abdominal surgery?
Cohort (n=1,487)
Yes
Does prolonged emergency department length of stay increase adverse perioperative outcomes in adult patients undergoing emergency orthopedic or abdominal surgery?
Prolonged emergency department length of stay increases the risk of adverse perioperative outcomes in low-risk patients undergoing emergency surgery, but appears protective in complex cases likely due to necessary preoperative optimization.
Warrants caution for surgical patients with prolonged ED stays; leaves open whether shortening boarding reduces adverse outcomes.
BACKGROUND: In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories. METHODS: A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. RESULTS: Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p < 0.001 for the interaction). CONCLUSION: Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases.
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Montes et al. (2019) conducted a cohort in Emergency surgery (orthopedic or abdominal) (n=1,487). Prolonged emergency department length of stay (>48 hours) vs. Emergency department length of stay ≤48 hours was evaluated on Adverse perioperative outcome during hospitalization (composite of in-hospital mortality, major cardiovascular adverse events, infection, renal failure, and severe bleeding) (OR 1.99, 95% CI 1.13-3.51, p=0.017). Prolonged emergency department length of stay (>48 hours) increased the risk of adverse perioperative outcomes (adjusted OR 1.99), particularly for patients without mortality risk factors (OR 2.52).
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