title: The excess morbidity and mortality of emergency general surgery.
abstract: BACKGROUND
  Emergency general surgery (EGS) carries a disproportionate burden of risk from medical errors, complications, and death compared with non-EGS (NEGS). Previous studies have been limited by patient and procedure heterogeneity but suggest worse outcome in EGS patients because of preoperative risk factors. The aim of this study was to quantify the excess burden of morbidity and mortality associated with EGS by controlling for patient-specific factors. We hypothesized that EGS is an independent risk factor for morbidity and mortality.
  
  
  METHODS
  We retrospectively analyzed data from the American College of Surgeons-National Surgical Quality Improvement Program. Fourteen procedures common to both EGS and NEGS from 2008 through 2012 were included. Patients were stratified based on emergency status. The primary outcome was death within 30 days of operation. Secondary outcomes were postoperative complications. Variables from the American College of Surgeons-National Surgical Quality Improvement Program preoperative risk assessment were analyzed. χ and Wilcoxon signed-rank tests were used to compare variables. Multivariate logistic regression was used to identify independent risk factors for mortality and complications.
  
  
  RESULTS
  Of 66,665 patients, 24,068 were EGS and 42,597 were NEGS. Mortality was 12.50% for EGS patients and 2.66% for NEGS patients (p < 0.0001). Major complications occurred in 32.80% of EGS patients and 12.74% of NEGS patients (p < 0.0001). When preoperative variables and procedure type were controlled, EGS was independently associated with death (odds ratio, 1.39; p = 0.029) and major complications (odds ratio, 1.31; p = 0.001).
  
  
  CONCLUSIONS
  EGS is an independent risk factor for death and postoperative complications. The excess morbidity and mortality of EGS are not fully explained by preoperative risk factors, making EGS an excellent target for quality improvement projects.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors.affiliation: From the Division of Trauma, Burns and Surgical Critical Care, (J.M.H., A.B.P., W.S.D., Z.C., E.K., R.A., A.S.), and Center for Surgery and Public Health, (J.M.H., Z.C., G.R., A.S.), Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.forename: Allan B
authors.initials: AB
authors.lastname: Peetz
authors.forename: Woo S
authors.initials: WS
authors.lastname: Do
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.forename: Edward
authors.initials: E
authors.lastname: Kelly
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000328:Adult; D000368:Aged; D004630:Emergencies; D005260:Female; D013502:General Surgery; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology