UBC Theses and Dissertations
Predictors of outcomes in emergency general surgery patients : a scoping review Al Hinai, Alreem
Background: Emergency General Surgery (EGS) patients have unique physiologic characteristics and are at a high risk of complications compared to elective general surgery patients. We aimed to perform a scoping review of the literature that examines predictors of outcomes in EGS patients. Methodology: A scoping review of published literature from 2004 to May 2015 was conducted in Medline, EMBASE, Cochrane library and PubMed. Keywords were chosen based on the three most common diagnoses in EGS; acute appendicitis, cholecystitis and small bowel obstruction, in addition to emergency general surgery, acute care surgery, outcomes & post-operative complications. Articles meeting inclusion criteria were summarized. Quantitative data regarding study characteristics were analyzed and expressed as descriptive statistics. Qualitative data from included studies were grouped intro predictors based on a framework derived from a grounded theory approach to content analysis. Primary outcomes of interest were post-operative morbidity and mortality. A predictor was included if it was significantly correlated with an outcome based on a minimum of bivariate analysis. Results: A total of 715 articles were identified during the primary search, of those 62 were found to be relevant to the search criteria. Almost all of the studies were retrospective. The median number of patients in these studies was 1000 (IQR 266,20896) with a mean of median/mean age reported of 53.2 years. Average length of follow up was 4.6 years. There were 54 predictors of outcome identified and these were grouped into patient related, process related and structure/system related predictors. The most frequently reported predictor of any adverse outcome was absence of an EGS system, followed by an ASA score of 3 or more. The most frequently reported predictor of post-operative morbidity was absence of EGS system. The most frequently reported predictor of mortality was age ≥ 65, emergency status and ASA ≥ 3. Conclusion: EGS patients are at a higher risk of post-operative adverse outcome as compared to elective surgical patients. System implementation significantly improves outcomes in this patient population. Identifying what predicts adverse outcomes can help in future risk assessment scores, planning future prospective trials and improving performance in emergency general surgery systems.
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