Complications and Their Association with Mortality Following Emergency Gastrointestinal Surgery—an Observational Study

• Published in: Journal of gastrointestinal surgery Vol. 26; no. 9; pp. 1930 - 1941
• Main Authors: Voldby, Anders Winther, Boolsen, Anders Watt, Aaen, Anne Albers, Burcharth, Jakob, Ekeløf, Sarah, Loprete, Roberto, Jønck, Simon, Eskandarani, Hassan Ali, Thygesen, Lau Caspar, Møller, Ann Merete, Brandstrup, Birgitte
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2022; Springer Nature B.V
• Subjects: Adult; Atrial Fibrillation - complications; Cardiac arrhythmia; Comorbidity; Digestive System Surgical Procedures - adverse effects; Gastroenterology; Gastrointestinal surgery; Humans; Intestinal Obstruction - etiology; Intestinal Obstruction - surgery; Medicine; Medicine & Public Health; Mortality; Observational studies; Original Article; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; Surgery; Thromboembolism; Perioperative care; Emergency; Complications; Gastrointestinal diseases; Outcomes
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-021-05240-6

Purpose Emergency 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. Methods We 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. Results Of 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. Conclusion This 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.