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Villodre C, Taccogna L, Zapater P, et al. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg. 2021;106168doi: 10.1016/j.ijsu.2021.106168.
Villodre, C., Taccogna, L., Zapater, P., Cantó, M., Mena, L., Ramia, J. M., Lluís, F. (2021). Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. International journal of surgery (London, England), 106168. https://doi.org/10.1016/j.ijsu.2021.106168
Villodre, C, et al. "Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study." International journal of surgery (London, England) vol. (2021): 106168. doi: https://doi.org/10.1016/j.ijsu.2021.106168
Villodre C, Taccogna L, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F. Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study. Int J Surg. 2021 Nov 13;106168. doi: 10.1016/j.ijsu.2021.106168. Epub 2021 Nov 13. PMID: 34785344.
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Int J Surg. 2021 Nov 13;106168. doi: 10.1016/j.ijsu.2021.106168. Epub 2021 Nov 13.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

International journal of surgery (London, England)

C Villodre, L Taccogna, P Zapater, M Cantó, L Mena, J M Ramia, F Lluís,

Affiliations

  1. Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain. Electronic address: [email protected].
  2. Department of Surgery, General University Hospital of Alicante, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
  3. Department of Clinical Pharmacology, General University Hospital of Alicante, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
  4. Computing, BomhardIP, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
  5. Department of Clinical Documentation, General University Hospital of Alicante, Alicante, Spain; Institute of Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.

PMID: 34785344 DOI: 10.1016/j.ijsu.2021.106168

Abstract

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-hour, 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.

Copyright © 2021. Published by Elsevier Ltd.

Keywords: Benchmarking; Emergency general surgery; Quality improvement; Risk-prediction

Conflict of interest statement

Declaration of competing interest None.

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