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Perioperative Risk Factors Impact Outcomes among Emergency versus Non-Emergency Surgery Differently
Jordan D Bohnen, MD, MBA1; Myriam M Martinez, MD1; Elie P Ramly, MD1; Naveen F Sangji, MD, MPH1,2; Thomas Peponis, MD1; Marc de Moya, MD1; D. Dante Yeh, MD1; Jarone Lee, MD MPH1,2; George C. Velmahos, MD, PhD1; David C. Chang, PhD, MBA, MPH2; Haytham MA Kaafarani, MD, MPH1,2
1Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 2Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA

Background:
Emergency surgery (ES) carries a different risk profile than non-emergency surgery (NES). Yet, little is known about how perioperative risk factors affect 30-day outcomes in ES vs NES. Design: Using the 2011-2012 ACS-NSQIP database, the 20 most common ES procedures were identified by CPT code. CPT codes with <300 observations were excluded. ES cases were defined as “Emergent” & “non-elective” per ACS-NSQIP criteria. Multivariable regression models were constructed to identify predictors of 30-day major morbidity or mortality (MMM)) in each group, controlling for demographics, ASA, co morbidities, preop labs, and procedure type. Odds Ratios of independent predictors of MMM were derived then compared between groups.

Results:
Of 986,034 patients, 170,131 met inclusion criteria (59,949 ES, 110,182 NES). Overall risk of MMM was significantly higher in ES vs NES (16.75% vs. 9.73%, p<0.001). Out of 40 ES and 38 NES-identified independent risk factors, preop transfusion and WBC?4.5 carried significantly higher risk of MMM in ES vs NES (Figure 1). Conversely, ascites, preop anemia, and leukocytosis (WBC 11-25) carried greater risk for MMM in NES. Laparoscopic cholecystectomy, laparotomy, umbilical and incisional herniorrhaphies were riskier in ESvs NES.

Conclusions:
Perioperative risk factors impact postoperative morbidity and mortality differently in ES vs NES. Instead of using the same risk-adjustment model for both ES and NES our findings strongly suggest the need to benchmark emergent and elective surgeries separately.



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