Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study
Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study
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DOI：
10.1136/tsaco-2020-000500
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发表时间：
2020-01-01
影响因子：
2
通讯作者：
Jansen, Jan O.
中科院分区：
文献类型：
--
作者：
Wohlgemut, Jared M.;Ramsay, George;Jansen, Jan O.
背景社会经济贫困和合并症对需要急诊普外科（EGS）住院患者预后的影响知之甚少。本研究的目的是探讨剥夺和合并症的影响，死亡率，出院目的地和住院时间（LOS）在接受EGS在Scotland. MethodsProphet收集的数据，从所有苏格兰成人患者（年龄>15岁）需要EGS承认1997年和2016年之间从苏格兰政府。资料包括年龄、性别、苏格兰多发性痴呆指数（SIMD）、5年Charlson合并症指数（CCI）、是否进行手术以及结局（包括死亡率、出院目的地和LOS）。采用Logistic回归分析死亡率和出院目的地，Poisson回归分析LOS。16.2%的人处于最贫困的SIMD十分位，5.6%的人处于最贫困的SIMD十分位。75.6%无合并症，20.3%有轻度合并症，2.5%有中度合并症，1.6%有重度合并症。78.6%直接出院回家。住院、30天、90天和1年的粗死亡率分别为1.7%、3.7%、7.2%和12.4%。Logistic回归分析显示，严重合并症与不能直接出院回家（OR 0.38，95%CI 0.37 ~ 0.39）和较高的住院死亡率（OR 13.74，95%CI 13.09 ~ 14.42）相关。与最富裕的人群相比，最贫困的人群不太可能直接出院回家（OR 0.97，95%CI 0.95 - 0.99），住院死亡率较高（OR 1.36，95%CI 1.8 - 1.46）。Poisson分析显示，严重合并症（OR 1.69，95%CI 1.68至1.69）和社会经济剥夺（OR 1.11，95%CI 1.11 - 1.12）与较长的LOS. DiscussionIncreasinglevels of comorbidity和，在较小程度上，社会经济剥夺是死亡率的关键驱动因素，出院目的地和入院EGS服务后的LOS。证据等级III（前瞻性/回顾性，最多两个阴性标准）。研究类型流行病学/预后。
BackgroundThe impact of socioeconomic deprivation and comorbidities on the outcome of patients who require emergency general surgery (EGS) admission is poorly understood. The aim of this study was to examine the effect of deprivation and comorbidity on mortality, discharge destination and length of hospital stay (LOS) in patients undergoing EGS in Scotland.MethodsProspectively collected data from all Scottish adult patients (aged >15 years) requiring EGS admitted between 1997 and 2016 were obtained from the Scottish Government. Data included age, sex, Scottish Index of Multiple Deprivation (SIMD), 5-year Charlson Comorbidity Index (CCI), whether an operation took place and outcomes including mortality, discharge destination and LOS. Logistic regression was used for the analysis of mortality and discharge destination and Poisson regression was used for LOS.Results1477810 EGS admissions were analyzed. 16.2% were in the most deprived SIMD decile and 5.6% in the least deprived SIMD decile. 75.6% had no comorbidity, 20.3% had mild comorbidity, 2.5% had moderate comorbidity and 1.6% had severe comorbidity. 78.6% were discharged directly home. Inpatient, 30-day, 90-day and 1-year crude mortality was 1.7%, 3.7%, 7.2% and 12.4%, respectively. Logistic regression showed that severe comorbidity was associated with not being discharged directly to home (OR 0.38, 95% CI 0.37 to 0.39) and higher inpatient mortality (OR 13.74, 95%CI 13.09 to 14.42). Compared with the most affluent population, the most deprived population were less likely to be discharged directly to home (OR 0.97, 95%CI 0.95 to 0.99) and had higher inpatient mortality (OR 1.36, 95%CI 1.8 to 1.46). Poisson analysis showed that severe comorbidity (OR 1.69, 95%CI 1.68 to 1.69) and socioeconomic deprivation (OR 1.11, 95%CI 1.11 to 1.12) were associated with longer LOS.DiscussionIncreased levels of comorbidity and, to a lesser extent, socioeconomic deprivation are key drivers of mortality, discharge destination and LOS following admission to an EGS service.Level of evidenceIII (prospective/retrospective with up to two negative criteria).Study typeEpidemiological/prognostic.