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Association between emergency department length of stay and adverse perioperative outcomes in emergency surgery: A cohort study in two Colombian University hospitals

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dc.creatorMontes, Félix R.spa
dc.creatorVásquez, Skarlet Marcellspa
dc.creatorCamargo-Rojas, Claudia Marcelaspa
dc.creatorRueda, Myriam V.spa
dc.creatorGóez-Mogollón, Linaspa
dc.creatorAlvarado, Paula A.spa
dc.creatorNovoa, Danny J.spa
dc.creatorVillar, Juan Carlosspa
dc.date.accessioned2020-05-26T00:03:05Z
dc.date.available2020-05-26T00:03:05Z
dc.date.created2019spa
dc.description.abstractBackground: In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories. Methods: A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. Results: Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p less than 0.001 for the interaction). Conclusion: Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases. © 2019 The Author(s).eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1186/s12873-019-0241-6
dc.identifier.issn1471227X
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/23560
dc.language.isoengspa
dc.publisherBioMed Central Ltd.spa
dc.relation.citationIssueNo. 1
dc.relation.citationTitleBMC Emergency Medicine
dc.relation.citationVolumeVol. 19
dc.relation.ispartofBMC Emergency Medicine, ISSN:1471227X, Vol.19, No.1 (2019)spa
dc.relation.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85064400084&doi=10.1186%2fs12873-019-0241-6&partnerID=40&md5=4c79ec6ae6650e6d435dc04241b7a419spa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.keywordAbdominal surgeryspa
dc.subject.keyworduniversityeng
dc.subject.keywordAdverse outcomespa
dc.subject.keywordAgespa
dc.subject.keywordAgedspa
dc.subject.keywordArticlespa
dc.subject.keywordBleedingspa
dc.subject.keywordCardiovascular diseasespa
dc.subject.keywordCohort analysisspa
dc.subject.keywordColombiaspa
dc.subject.keywordComorbidityspa
dc.subject.keywordControlled studyspa
dc.subject.keywordEmergency surgeryspa
dc.subject.keywordEmergency wardspa
dc.subject.keywordFemalespa
dc.subject.keywordHospital mortalityspa
dc.subject.keywordHumanspa
dc.subject.keywordIncidencespa
dc.subject.keywordInfectionspa
dc.subject.keywordKidney failurespa
dc.subject.keywordLength of stayspa
dc.subject.keywordMajor clinical studyspa
dc.subject.keywordMalespa
dc.subject.keywordOperation durationspa
dc.subject.keywordOrthopedic surgeryspa
dc.subject.keywordPerioperative periodspa
dc.subject.keywordPreoperative periodspa
dc.subject.keywordRetrospective studyspa
dc.subject.keywordRisk factorspa
dc.subject.keywordEmergency treatmentspa
dc.subject.keywordEpidemiologyspa
dc.subject.keywordHospital emergency servicespa
dc.subject.keywordHospital mortalityspa
dc.subject.keywordLength of stayspa
dc.subject.keywordMiddle agedspa
dc.subject.keywordPerioperative periodspa
dc.subject.keywordUniversity hospitalspa
dc.subject.keywordAgedspa
dc.subject.keywordColombiaspa
dc.subject.keywordDigestive system surgical proceduresspa
dc.subject.keywordEmergency serviceeng
dc.subject.keywordEmergency treatmentspa
dc.subject.keywordFemalespa
dc.subject.keywordHospital mortalityspa
dc.subject.keywordHospitalseng
dc.subject.keywordHumansspa
dc.subject.keywordLength of stayspa
dc.subject.keywordMalespa
dc.subject.keywordMiddle agedspa
dc.subject.keywordOrthopedic proceduresspa
dc.subject.keywordPerioperative periodspa
dc.subject.keywordRetrospective studiesspa
dc.subject.keywordRisk factorsspa
dc.subject.keywordEmergency departmentspa
dc.subject.keywordEmergency surgeryspa
dc.subject.keywordLength of stayspa
dc.subject.keywordOutcomespa
dc.titleAssociation between emergency department length of stay and adverse perioperative outcomes in emergency surgery: A cohort study in two Colombian University hospitalsspa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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