Factors affecting morbidity in emergency general surgery

Background: Emergency status adversely affects surgical outcomes. Predictors of increased morbidity of emergency general surgery are unknown. We determined predictors of postoperative complications of emergency general surgery. Methods: We conducted a retrospective study of Brigham and Women's Hospital American College of Surgeons National Surgical Quality Improvement Program patients who had an emergency general surgery procedure from January 1, 2007, to December 31, 2009. Additional nonAmerican College of Surgeons National Surgical Quality Improvement Program variables were collected. Our primary outcome was postoperative complications within 30 days. Results: Of 819 cases, 24.7% had 1 or more complications, with 8.9% mortality within 30 days. Common complications were respiratory (47%) and wound occurrences (18%). Age, sex, blood glucose level, creatinine level, albumin level, surgery duration, and smoking were independent predictors of morbidity. Conclusions: Emergency general surgery patients with postoperative complications are likely to be older, male, smokers, have increased blood glucose and creatinine levels, lower albumin levels, and longer surgical times. Fluid resuscitation and experienced surgical teams are putative targets to improve outcomes.