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. Material and 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.

Key Words:

• emergency abdominal surgery
• high-risk surgery
• mortality
• sepsis
• surgical delay

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.