부산대학교 도서관

Background: Most of the literature on emergency general surgery (EGS) has investigated appendiceal and biliary disease; however, EGS surgeons manage many other complex conditions. This study aimed to describe the operative burden of these conditions throughout Canada. Methods: This multicentre retrospective cohort study evaluated EGS patients at 7 centres across Canada in 2014. Adult patients (aged > 18 yr) undergoing nonelective operative interventions for nonbiliary, nonappendiceal diseases were included. Data collected included information on patients' demographic characteristics, diagnosis, procedure details, complications and hospital length of stay. Logistic regression was used to identify predictors of morbidity and mortality. Results: A total of 2595 patients were included, with a median age of 60 years (interquartile range 46-73 yr). The most common principal diagnoses were small bowel obstruction (16%), hernia (15%), malignancy (11 %) and perianal disease (9%). The most commonly performed procedures were bowel resection (30%), hernia repair (15%), adhesiolysis (11%) and debridement of skin and soft tissue infections (10%). A total of 47% of cases were completed overnight (between 5 pm and 8 am). The overall in-hospital mortality rate was 8%. Thirty-three percent of patients had a complication, with independent predictors including increasing age (p = 0.001), increasing American Society of Anesthesiologists score (p = 0.02) and transfer from another centre (p = 0.001). Conclusion: This study characterizes the epidemiology of nonbiliary, nonappendiceal EGS operative interventions across Canada. Canadian surgeons are performing a large volume of EGS, and conditions treated by EGS services are associated with a substantial risk of morbidity and mortality. Results of this study will be used to guide future research efforts and set benchmarks for quality improvement. Contexte : La plupart des etudes sur les services de chirurgie generate d'urgence (CGU) s'interessent seulement aux atteintes de l'appendice et de la vesicule biliaire. Pourtant, les chirurgiens du domaine traitent beaucoup d'autres problemes complexes. L'objectif de Petude etait de decrire le travail chirurgical associe a ces problemes dans l'ensemble du Canada. Methodes : Notre etude de cohorte retrospective multicentrique inclut les patients adultes ([greater than or equal to] 18 ans) qui ont subi en 2014 une operation non planifiee pour une atteinte qui ne touchait ni l'appendice ni la vesicule biliaire dans 1 des 7 centres selectionnes, repartis un peu part out au pays. Nous avons recueilli les donnees suivantes : renseignements de base des patients, diagnostic, details de l'intervention, nature des complications et duree d'hospitalisation. Puis nous avons degage les facteurs predictifs de morbidite et de mortalite en appliquant un modele de regression logistique. Resultats : L'echantillon totalisait 2595 patients, pour un age median de 60 ans (ecart interquartile 46-73 ans). Les diagnostics principaux les plus courants etaient l'occlusion de l'intestin grele (16%), la hernie (15 %), la tumeur maligne (11 %) et les lesions perianales (9%). Les interventions les plus frequentes etaient la resection de l'intestin (30%), la reparation d'une hernie (15%), le debridement (11 %) et le debridement de tissus mous ou cutanes infectes (10 %). L'operation a eu lieu le soir ou la nuit (entre 17 h et 8 h) dans 47 % des cas. Le taux global de mortalite a l'hopital etait de 8 %. Des complications sont survenues chez 33% des patients, dont les facteurs predictifs independants etaient Page avance (p = 0,001), un score ASA (de l'American Society of Anesthesiologists) eleve (p = 0,02) et le transfert a partir d'un autre centre (p = 0,001). Conclusion : Cette etude dresse le profil epidemiologique des interventions effectuees par les services de CGU du Canada en presence d'atteintes autres que celles de l'appendice et de la vesicule biliaire. Les chirurgiens du pays font beaucoup d'interventions generates urgent es, pour traiter des affections associees a un risque eleve de morbidite et de mortalite. Les resultats de Petude guideront les prochaines recherches et serviront de points de reference en matiere d'amelioration de la qualite.
Emergency general surgery (EGS) is associated with a tremendous burden of disease. In the United States, EGS admissions represent 7% of all hospital admissions, and in 2010 they cost the [...]