Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients

Authors

Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Maru Kim, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Timothy Allison-Aipa, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Bishoy Zakhary, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Junsik Kwon, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Matthew Firek, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Bruno Cammarota Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System, Moreno Valley, CA, USA.
Todd W. Costantini, Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA.
Laura N. Haynes, Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, University of California San Diego, San Diego, CA, USA.
Sara B. Edwards, Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Department of Surgery, University of California Riverside, Moreno Valley, CA, USA.

Document Type

Journal Article

Publication Date

4-24-2024

Journal

The American surgeon

DOI

10.1177/00031348241248796

Keywords

complications; emergency general surgery; failure-to-rescue; mortality; readmissions

Abstract

INTRODUCTION: We have recently shown that readmission after EGS procedures carries a 4-fold higher mortality rate when compared to those not readmitted. Understanding factors associated with death after readmission is paramount to improving outcomes for EGS patients. We aimed to identify risk factors contributing to failure-to-rescue (FTR) during readmission after EGS. We hypothesized that most post-readmission deaths in EGS are attributable to FTR. METHODS: A retrospective cohort study using the NSQIP database 2013-2019 was performed. Patients who underwent 1 of 9 urgent/emergent surgical procedures representing 80% of EGS burden of disease, who were readmitted within 30 days post-procedure were identified. The procedures were classified as low- and high-risk. Patient characteristics analyzed included age, sex, BMI, ASA score comorbidities, postoperative complications, frailty, and FTR. The population was assessed for risk factors associated with mortality and FTR by uni- and multivariate logistic regression. RESULTS: Of 312,862 EGS cases, 16,306 required readmission. Of those, 10,748 (3.4%) developed a postoperative complication. Overall mortality after readmission was 2.4%, with 90.6% of deaths attributable to FTR. Frailty, high-risk procedures, pulmonary complications, AKI, sepsis, and the need for reoperation increased the risk of FTR. DISCUSSION: Death after a complication is common in EGS readmissions. The impact of FTR could be minimized with the implementation of measures to allow early identification and intervention or prevention of infectious, respiratory, and renal complications.

APA Citation

Coimbra, Raul; Kim, Maru; Allison-Aipa, Timothy; Zakhary, Bishoy; Kwon, Junsik; Firek, Matthew; Coimbra, Bruno Cammarota; Costantini, Todd W.; Haynes, Laura N.; and Edwards, Sara B., "Deaths After Readmissions are Mostly Attributable to Failure-to-Rescue in EGS Patients" (2024). GW Authored Works. Paper 4680.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4680

Department

School of Medicine and Health Sciences Student Works