Key result
m-LUCENTUM risk stratification establishes a ~1% mortality benchmark for low-risk emergency general surgery.
Why the study?
Emergency General Surgery is practiced without benchmarking-based quality improvement programs despite accounting for millions of deaths worldwide.
Cohort (n=7,258)
Yes
This study establishes clinically-based benchmark values for Emergency General Surgery in a low-risk cohort to guide quality improvement initiatives.
May support quality benchmarking in low-risk emergency surgery; leaves open prospective validation before practice adoption.
Background and aims Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. Methods Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. Results A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101–500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500–1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. Conclusions This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement. Highlights The best benchmark cut-offs in Emergency General Surgery are unknown. The present study established benchmark cut-off values in a low-risk cohort. Benchmark cut-off was ≥40.9% for use of laparoscopy, and ≤3 days for hospital stays. Benchmark cut-off was ≤17.7% for 30-day morbidity, and ≤1.1% for 30-day mortality. These cut-offs values may guide quality improvement in Emergency General Surgery.
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Villodre et al. (2021) conducted a cohort in Emergency General Surgery (EGS) (n=7,258). Emergency General Surgery was evaluated on Benchmark cutoffs for low-risk cohort (use of laparoscopy, length of hospital stay, 30-day morbidity, 30-day mortality). In a low-risk emergency general surgery cohort, benchmark cut-offs were established as ≥40.9% for laparoscopy use, ≤3 days for hospital stay, ≤17.7% for 30-day morbidity, and ≤1.1% for mortality.
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