Availability of acute care surgeons improves outcomes in patients requiring emergent colon surgery.
BACKGROUND
The need for emergent colon surgery is a common cause of severe sepsis/septic shock and mortality among surgical patients. We wanted to benchmark our outcomes against those of the National Surgical Quality Improvement Program (NSQIP). We hypothesized that having acute care surgeons to provide comprehensive perioperative care and rapid source control surgery would improve outcome.


METHODS
We queried the 2005 to 2007 NSQIP dataset and our prospective database for patients with severe sepsis/septic shock requiring emergency colon surgery. Demographics, Acute Physiology and Chronic Health Evaluation II score, sepsis source, and hospital mortality data were obtained for all patients.


RESULTS
Both cohorts were similar with regard to age and sex. The overall mortality rate for patients in our dataset was 28.3% compared with 40.1% in the NSQIP dataset (P = .06). The average Acute Physiology and Chronic Health Evaluation II score for our patients was 31 ± 8.2 with a predicted mortality rate of 73% (P < .0001 when compared with actual mortality rate of 28.3%).


CONCLUSIONS
Patients with severe sepsis/septic shock requiring emergent colon surgery have a high mortality rate. Delivery of comprehensive emergency surgical care by acute care surgeons appears to improve survival.
Department of Surgery, The University of Texas Health Science Center, Houston, TX 77030, USA. laura.j.moore@uth.tmc.edu
Laura J
LJ
Moore
Krista L
KL
Turner
Stephen L
SL
Jones
Bridget N
BN
Fahy
Frederick A
FA
Moore
D000368:Aged; D019985:Benchmarking; D003082:Colectomy / Q000401:mortality*; D003108:Colonic Diseases / Q000601:surgery*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014481:United States / Q000453:epidemiology