Complications and Their Association with Mortality Following Emergency Gastrointestinal Surgery - an Observational study
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Complications and Their Association with Mortality Following Emergency Gastrointestinal Surgery - an Observational study. / Voldby, Anders Winther; Boolsen, Anders Watt; Aaen, Anne Albers; Burcharth, Jakob; Ekeløf, Sara; Loprete, Roberto; Jønck, Simon; Eskandarani, Hassan Ali; Thygesen, Lau Casper; Møller, Ann; Brandstrup, Birgitte.
In: Journal of Gastrointestinal Surgery, Vol. 26, 2022, p. 1930–1941.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Complications and Their Association with Mortality Following Emergency Gastrointestinal Surgery - an Observational study
AU - Voldby, Anders Winther
AU - Boolsen, Anders Watt
AU - Aaen, Anne Albers
AU - Burcharth, Jakob
AU - Ekeløf, Sara
AU - Loprete, Roberto
AU - Jønck, Simon
AU - Eskandarani, Hassan Ali
AU - Thygesen, Lau Casper
AU - Møller, Ann
AU - Brandstrup, Birgitte
PY - 2022
Y1 - 2022
N2 - PurposeEmergency gastrointestinal surgery is followed by a high risk of major complications and death. This study aimed to investigate which complications showed the strongest association with death following emergency surgery for gastrointestinal obstruction or perforation.MethodsWe retrospectively included adults who had undergone emergency gastrointestinal surgery for radiologically verified obstruction or perforation at three Danish hospitals between 2014 and 2015. The exposure variables comprised 16 predefined Clavien-Dindo-graded complications. Cox regression with delayed entry was used to analyze the association of these complications with 90-day mortality. We adjusted for hospital, age, American Society of Anesthesiologists classification, pre-operative Sepsis-2 score, cardiac comorbidity, renal comorbidity, hypertension, active cancer, bowel obstruction or perforation, and the surgical procedure. Subgroup analyses were done for patients with gastrointestinal obstruction or perforation.ResultsOf the 349 included patients, 281 (80.5%) experienced at least one complication. The risk of death was 20.6% (14) for patients with no complications and varied between 21 and 57% for patients with complications. Renal impairment (hazard ratio (HR): 6.8 (95%CI: 3.7–12.4)), arterial thromboembolic events (HR 4.8 (2.3–9.9)), and atrial fibrillation (HR 4.4 (2.8–6.8)) showed the strongest association with 90-day mortality. Atrial fibrillation was the only complication significantly associated with death in patients with gastrointestinal obstruction as well as perforation.ConclusionThis study of patients undergoing emergency gastrointestinal surgery revealed that renal impairment, arterial thromboembolic events, and atrial fibrillation had the strongest association with death. Atrial fibrillation may serve as an in-situ marker of patients needing escalation of care.
AB - PurposeEmergency gastrointestinal surgery is followed by a high risk of major complications and death. This study aimed to investigate which complications showed the strongest association with death following emergency surgery for gastrointestinal obstruction or perforation.MethodsWe retrospectively included adults who had undergone emergency gastrointestinal surgery for radiologically verified obstruction or perforation at three Danish hospitals between 2014 and 2015. The exposure variables comprised 16 predefined Clavien-Dindo-graded complications. Cox regression with delayed entry was used to analyze the association of these complications with 90-day mortality. We adjusted for hospital, age, American Society of Anesthesiologists classification, pre-operative Sepsis-2 score, cardiac comorbidity, renal comorbidity, hypertension, active cancer, bowel obstruction or perforation, and the surgical procedure. Subgroup analyses were done for patients with gastrointestinal obstruction or perforation.ResultsOf the 349 included patients, 281 (80.5%) experienced at least one complication. The risk of death was 20.6% (14) for patients with no complications and varied between 21 and 57% for patients with complications. Renal impairment (hazard ratio (HR): 6.8 (95%CI: 3.7–12.4)), arterial thromboembolic events (HR 4.8 (2.3–9.9)), and atrial fibrillation (HR 4.4 (2.8–6.8)) showed the strongest association with 90-day mortality. Atrial fibrillation was the only complication significantly associated with death in patients with gastrointestinal obstruction as well as perforation.ConclusionThis study of patients undergoing emergency gastrointestinal surgery revealed that renal impairment, arterial thromboembolic events, and atrial fibrillation had the strongest association with death. Atrial fibrillation may serve as an in-situ marker of patients needing escalation of care.
KW - Faculty of Health and Medical Sciences
U2 - 10.1007/s11605-021-05240-6
DO - 10.1007/s11605-021-05240-6
M3 - Journal article
C2 - 35606601
VL - 26
SP - 1930
EP - 1941
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
ER -
ID: 310230184