Logistics and outcome in urgent and emergency colorectal surgery

Colorectal Dis. 2010 Oct;12(10 Online):e255-9. doi: 10.1111/j.1463-1318.2009.02120.x.

Abstract

Aim: Infrastructure-related factors are seldom described in detail in studies on outcome after surgical procedures. We studied patient, procedure, physician and infrastructure characteristics and their effect on outcome at a Norwegian University hospital.

Method: All patients admitted between 1st January 2002 and 30th June 2003 who underwent urgent or emergency colorectal surgery were extracted from the hospital databases and retrospectively analysed.

Results: There were 196 patients. The overall complication rate was 39%. Forty-six (24%) patients died during admission after surgery. Those who died were less likely to be operated by a subspecialized colorectal surgeon (17%vs 30%, P = 0.001). The anaesthesiologist was a resident in most of the cases (> 75%) for both those who survived and those who died. Surgery performed out-of-office hours was common in both groups, although the patients who died were more likely to be operated upon at night (28%vs 18%, P = 0.001). The time interval standard from admission to surgery was met in only 84 (43%) patients. Forty-nine (49/196, 25%) procedures were delayed beyond the time requested by the surgeon by more than 120 min (mean 363 min).

Conclusion: The outcome after emergency colorectal surgery was consistent with the literature but the infrastructure was not optimal. Improvements may be achieved by a focus on decreasing waiting times, abandoning of out-of-office emergency surgery and increasing the involvement of senior staff.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • After-Hours Care / organization & administration
  • Aged
  • Aged, 80 and over
  • Clinical Competence
  • Colonic Diseases / mortality
  • Colonic Diseases / surgery*
  • Emergencies
  • Emergency Service, Hospital / organization & administration*
  • Hospital Mortality
  • Hospitals, University / organization & administration*
  • Humans
  • Intestinal Obstruction / surgery*
  • Middle Aged
  • Norway
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications*
  • Rectal Diseases / mortality
  • Rectal Diseases / surgery*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Workforce
  • Young Adult