title: A critical assessment of outcomes in emergency versus nonemergency general surgery using the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: Emergent operations are thought to carry higher morbidity and mortality than nonemergent cases. However, there is a lack of specific outcomes data for emergent general surgery procedures. The objective of our study was to assess and quantify postoperative morbidity and mortality for  emergency versus nonemergency general surgery operations. All general surgery inpatients were identified in the American College of Surgeons National Surgical Quality Improvement Program 2008 database. Preoperative, intraoperative, and postoperative clinical metrics and occurrences  were assessed. A total of 25,770 emergent and 98,867 nonemergent cases were identified. Postoperative morbidity was significantly worse in the emergent group, including ventilation more than 48 hours, bleeding requiring transfusion, deep vein thrombosis, renal failure, and need for reoperation.  Overall, emergent cases had significantly more postoperative complications (22.8% vs 14.2%) and higher mortality rates (6.5% vs 1.4%). General surgery patients who undergo emergent operations have significantly poorer outcomes when compared with nonemergent patients; our analysis  has quantified these differences. Emergent patients seem to manifest unique clinical, pathophysiologic, and inflammatory responses to their surgical disease. This data suggests that there is a need for improvement in both methods and systems of care for the emergent population.
authors.affiliation: Acute Care Surgery Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. rbecher@wfubmc.edu
authors.forename: Robert D
authors.initials: RD
authors.lastname: Becher
authors.forename: J Jason
authors.initials: JJ
authors.lastname: Hoth
authors.forename: Preston R
authors.initials: PR
authors.lastname: Miller
authors.forename: Nathan T
authors.initials: NT
authors.lastname: Mowery
authors.forename: Michael C
authors.initials: MC
authors.lastname: Chang
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
mesh_terms: D000368:Aged; D016208:Databases, Factual; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000592:standards*; D016896:Treatment Outcome; D014481:United States