Logistics and outcome in urgent and emergency colorectal surgery.
OBJECTIVE
Infrastructure-related factors are seldom described in detail in studies on outcome after surgical procedures. We studied patient, procedure, physician and infrastructure characteristics and their effect on outcome at a Norwegian University hospital.


METHODS
All patients admitted between 1st January 2002 and 30th June 2003 who underwent urgent or emergency colorectal surgery were extracted from the hospital databases and retrospectively analysed.


RESULTS
There were 196 patients. The overall complication rate was 39%. Forty-six (24%) patients died during admission after surgery. Those who died were less likely to be operated by a subspecialized colorectal surgeon (17%vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients who died were more likely to be operated upon at night (28%vs 18%, P = 0.001). The time interval standard from admission to surgery was met in only 84 (43%) patients. Forty-nine (49/196, 25%) procedures were delayed beyond the time requested by the surgeon by more than 120 min (mean 363 min).


CONCLUSIONS
The outcome after emergency colorectal surgery was consistent with the literature but the infrastructure was not optimal. Improvements may be achieved by a focus on decreasing waiting times, abandoning of out-of-office emergency surgery and increasing the involvement of senior staff.
Elshove-Bolk
J
J
Department of Anaesthesia, Kongsberg Hospital, Vestre Viken HF, Kongsberg, Norway. jhwelshove@c2i.net
Ellensen
V S
VS
Baatrup
G
G
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003108:Colonic Diseases / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D007415:Intestinal Obstruction / Q000601:surgery*; D008875:Middle Aged; D009664:Norway; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce; D055815:Young Adult