title: Association between surgical delay and survival in high-risk emergency abdominal surgery. A population-based Danish cohort study.
abstract: OBJECTIVE
  In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general.
  
  
  METHODS
  All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression.
  
  
  RESULTS
  A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding.
  
  
  CONCLUSIONS
  In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.
authors.affiliation: a 1 Departments of Anaesthesiology and Intensive Care Medicine, Køge Hospital and Herlev Hospital , Herlev, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Vester-Andersen
authors.affiliation: b 2 Department of Anaesthesiology and Intensive Care Medicine, Nordsjællands Hospital , Hillerød, Denmark.
authors.forename: Lars Hyldborg
authors.initials: LH
authors.lastname: Lundstrøm
authors.affiliation: c 3 Department of Anaesthesiology and Intensive Care Medicine, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark.
authors.forename: David Levarett
authors.initials: DL
authors.lastname: Buck
authors.affiliation: d 4 Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark.
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003718:Denmark; D004630:Emergencies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012042:Registries; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D013997:Time Factors
keywords: emergency abdominal surgery; high-risk surgery; mortality; sepsis; surgical delay