Does Delayed Operation Increase Morbidity and Mortality? An Analysis of Emergency General Surgery Procedures.

BACKGROUND: Early operation is assumed to improve outcomes after emergency general surgery (EGS) procedures; however, few data exist to inform this opinion. We aimed to (1) characterize time-to-operation patterns among EGS procedures and (2) test the association between timing and patient outcomes. We hypothesize that patients receiving later operations are at greater risk for mortality and morbidity.

METHODS: We performed a retrospective cohort study of the ACS National Surgical Quality Improvement Program (ACS-NSQIP) data for adults ages 18-89 who underwent non-elective intra-abdominal operations (appendectomy, cholecystectomy, small bowel resection, lysis of adhesions, and colectomy) from 2015-2020. The primary outcome was 30-day postoperative mortality. Secondary outcomes were serious morbidity and all morbidity. Admission-to-operation timing was calculated and classified as early (≤ 48 hours) or late (> 48 hours). A multivariable logistic regression model adjusted risk estimates for age, comorbidities, frailty (mFI-5), and other confounders.

RESULTS: Of 269,959 patients (mean age 47.0 years; 48.0 % male, 61.6% white), 88.7% underwent early operation, ranging from 70.36% (lysis of adhesions) to 98.67% (appendectomy). Unadjusted 30-day mortality was higher for late versus early operation (6.73% vs. 1.96%; p < 0.0001). After risk-adjustment, late operation significantly increased risk for 30-day mortality (OR 1.545, 95% CI 1.451 - 1.644), serious morbidity (OR 1.464, 95% CI 1.416-1.514), and all morbidity (OR 1.468, 95% CI 1.417-1.520). This mortality risk persisted for all EGS procedures; risk of serious and any morbidity persisted for all procedures except cholecystectomy.

CONCLUSIONS: Late operation significantly increased risk for 30-day mortality, serious morbidity, and all morbidity across a variety of EGS procedures. We believe these findings will inform decisions regarding timing of EGS operations and allocation of surgical resources.

LEVEL OF EVIDENCE: Level III.