title: Emergency general surgery in a low-middle income health care setting: Determinants of outcomes.
abstract: BACKGROUND
  Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context.
  
  
  METHODS
  March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors.
  
  
  RESULTS
  A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%).
  
  
  CONCLUSIONS
  This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide.
authors.affiliation: Department of Surgery, The Aga Khan University, Karachi, Pakistan; Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Adil A
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Asad
authors.initials: A
authors.lastname: Latif
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Department of Surgery, Howard University College of Medicine, Washington, DC.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Robert
authors.initials: R
authors.lastname: Riviello
authors.affiliation: Section of Critical Care, Department of Medicine, The Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad Sohail
authors.initials: MS
authors.lastname: Halim
authors.affiliation: Department of Surgery, The Aga Khan University, Karachi, Pakistan.
authors.forename: Zia
authors.initials: Z
authors.lastname: Rehman
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, The Aga Khan University, Karachi, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003906:Developing Countries / Q000706:statistics & numerical data*; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D013502:General Surgery; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D055815:Young Adult