Twenty-year study of in-hospital and postdischarge mortality following emergency general surgical admission

Abstract

Background: Emergency general surgery (EGS) patients have a higher mortality than those having elective surgery. Few studies have investigated changes in EGS-associated mortality over time or explored mortality rates after discharge. The aim of this study was to conduct a comprehensive, population-based analysis of mortality in EGS patients over a 20-year time frame. Methods: This was a cross-sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co-morbidities were defined by Charlson Co-morbidity Index, and operations were coded by OPCS-4 classifications. Linear and multivariable logistic regression models were used to evaluate changes over time. Results: Among 1 450 296 patients, the overall inpatient, 30-day, 90-day and 1-year mortality rates were 1.8, 3.8, 6.4 and 12.5 per cent respectively. Mortality was influenced by age at admission, co-morbidity, operation performed and date of admission (all P < 0.001), and improved with time on subgroup analysis by age, co-morbidity and operation status. Medium-term mortality was high: the 1-year mortality rate in patients aged over 75 years was 35.6 per cent. The 1-year mortality rate in highly co-morbid patients decreased from 75.1 to 57.1 per cent over the time frame of the study (P < 0.001). Conclusion: Mortality after EGS in Scotland has reduced significantly over the past 20 years. This analysis of medium-term mortality after EGS admission demonstrates strikingly high rates, and postdischarge death rates are higher than is currently appreciated.