Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: A cohort study in two Colombian University hospitals

Félix R. Montes, Skarlet Marcell Vásquez, Claudia Marcela Camargo-Rojas, Myriam V. Rueda, Lina Góez-Mogollón, Paula A. Alvarado, Danny J. Novoa, Juan Carlos Villar

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Article number27
JournalBMC Emergency Medicine
Volume19
Issue number1
DOIs
StatePublished - 17 Apr 2019

Keywords

  • Emergency department
  • Emergency surgery
  • Length of stay
  • Outcome

Fingerprint

Dive into the research topics of 'Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: A cohort study in two Colombian University hospitals'. Together they form a unique fingerprint.

Cite this