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Factors affecting mortality after emergency surgery: beyond time of day

Last post 04 Nov 2018, 9:09 PM by Yasser Kamal. 0 replies.
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  •  04 Nov 2018, 9:09 PM 2682

    Factors affecting mortality after emergency surgery: beyond time of day

    Tessler et al. did not find an association between the time of day and 30-day mortality after emergency surgery [1]. Evaluating the factors associated with early postoperative mortality in emergency surgery may help development of reasonable preventive measures to improve treatment planning, the consent process and postoperative outcome. The authors ackowledged some study limitations in their paper, including deficiencies in patient morbidity and time to surgery, data but we would like to invite the authors to comment on further concerns that we have.

    Firstly, the authors adjusted the logistic regression for anaesthesia duration and type of surgery, but not other risk factors, such as ASA physical status. ASA physical status is a significant predictor of in-hospital mortality after emergency surgery [2], and increasing ASA physical status is associated with greater mortality within 48 hours after both elective and emergency surgery [3]. Five other preoperative variables are involved in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 30-day mortality calculator following emergency general surgery - age, non-independent status, sepsis, BUN and albumin [4]. Do the authors think that these and/or other confounding varables might have affected their results?

    Secondly, it was not known how long patients waited for surgery, but pre-operative delay results in higher postoperative morbidity and mortality [5]. Although the authors assumed that staff fatigue would be similar between their three time periods (day, evening, night) as most would become similarly tired througout their shift, this may not hold true for all staff, and surgeons' performance may decline after more prolonged periods of sleep deprivation [6, 7]. To what degree do the authors think that surgical and anaesthetic sleep deprivation may have been a factor affecting their results?

    Y. A. Kamal

    Minia University,

    El-Minya, Egypt.

    E-mail: yaser_ali_kamal@yahoo.com.

     

    No external funding and no conflicts of interest declared.

     

    References

    1. Tessler MJ, Charland L, Wang NN, Correa JA. The association of time of emergency surgery – day, evening or night – with postoperative 30-day hospital mortality. Anaesthesia 2018; 73: 1368-71.

    2. Shah AA, Latif A, Zogg CK, et al. Emergency general surgery in a low-middle income health care setting: determinants of outcomes. Surgery 2016; 159: 641-9.

    3. Hopkins TJ, Raghunathan K, Barbeito A, et al. Associations between ASA Physical Status and postoperative mortality at 48 h: a contemporary dataset analysis compared to a historical cohort. Perioperative Medicine (London) 2016; 5: 29.

    4. Haskins IN, Maluso PJ, Schroeder ME, et al. A calculator for mortality following emergency general surgery based on the American College of Surgeons National Surgical Quality Improvement Program database. Journal of Trauma and Acute Care Surgery 2017; 82:1094-9.

    5. Adamu A, Maigatari M, Lawal K, Iliyasu M. Waiting time for emergency abdominal surgery in Zaria, Nigeria. African Health Sciences 2010; 10: 46-53.

    6. Olasky J, Chellali A, Sankaranarayanan G, et al. Effects of sleep hours and fatigue on performance in laparoscopic surgery simulators. Surgical Endoscopy 2014; 28: 2564-8.

    7. Parker RS, Parker P. The impact of sleep deprivation in military surgical teams: a systematic review. Journal of the Royal Army Medical Corps 2017; 163: 158-63.


    Yasser Ali
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