Abstract
BACKGROUND: Emergency surgery (ES) is associated with a significantly higher risk of perioperative complications, including infectious, compared with elective surgery. This study aimed to identify the impact of time to surgical procedure and operative duration on infectious complications after ES.
PATIENTS AND METHODS: The 2013-2017 American College of Surgeons National Surgical Quality Improvement Program database was utilized to identify all ES patients ≥18 years using the variable "Emergency." Delayed surgical procedure was defined as >12 h and prolonged surgical procedure as >2 h. Multivariable logistic regression adjusting for age, comorbidities, and surgical approach was used to investigate the impact of delayed and prolonged surgical procedure on postoperative infection, defined as the presence of sepsis, septic shock, surgical site infection (i.e., superficial, deep incisional, and organ space), pneumonia, and urinary tract infection. Sensitivity analyses were performed to examine the same relationship in emergency general surgery (EGS), identified with Current Procedural Terminology codes, and three subsets of EGS patients: exploratory laparotomy, cholecystectomy, and appendectomy.
RESULTS: Out of 4,299,148 patients, 264,213 were included, of which 24,921 (9.4%) had postoperative infections. Patients with infectious complications were more likely to have comorbidities (e.g., obesity, diabetes), an open surgical approach, delayed surgical procedure (50.4% vs. 39.4%, p < 0.001), and prolonged surgical procedure (31.6% vs. 14.3%, p < 0.001). On multivariable analyses, delayed surgical procedure was significantly associated with a 14% higher risk of postoperative infection (adjusted odds ratios [aOR] 1.14; 95% confidence interval [CI] 1.1-1.18), and prolonged surgical procedure was significantly associated with twice the risk (aOR: 1.99; CI: 1.91-2.08). Similarly, delayed and prolonged surgical procedure were significantly associated with infectious complications in the subset of EGS patients (aOR: 1.16; CI: 1.11-1.22, aOR: 1.91; CI: 1.82-2.02, respectively). When examining the 3 sensitivity subsets of patients, prolonged surgical procedure was significantly associated with infectious complications in all cohorts (aOR: 1.45; CI: 1.28-1.64 in exploratory laparotomy, aOR: 1.93; CI: 1.52-2.46 in cholecystectomy, aOR: 2.06; CI: 1.69-2.53 in appendectomy), whereas delayed surgical procedure was significantly associated with infectious complications only in exploratory laparotomy (aOR: 1.23; CI: 1.13-1.33).
CONCLUSIONS: Delayed and prolonged surgical procedure are independently associated with increased risk of infectious complications in ES patients, including those undergoing EGS procedures. These findings highlight the importance of early and efficient surgical interventions in ES.