Causes of death after emergency general surgical admission: population cohort study of mortality.

G Ramsay,J M Wohlgemut,M Bekheit,J O Jansen,A J M Watson

doi:10.1093/bjsopen/zrab021

Abstract

BackgroundA substantial number of patients treated in emergency general surgery (EGS) services die within a year of discharge. The aim of this study was to analyse causes of death and their relationship to discharge diagnoses, in patients who died within 1 year of discharge from an EGS service in Scotland.MethodsThis was a population cohort study of all patients with an EGS admission in Scotland, UK, in the year before death. Patients admitted to EGS services between January 2008 and December 2017 were included. Data regarding patient admissions were obtained from the Information Services Division in Scotland, and cross-referenced to death certificate data, obtained from the National Records of Scotland.ResultsOf 507 308 patients admitted to EGS services, 7917 died while in hospital, and 52 094 within 1 year of discharge. For the latter, the median survival time was 67 (i.q.r. 21–168) days after EGS discharge. Malignancy accounted for 48 per cent of deaths and was the predominant cause of death in patients aged over 35 years. The cause of death was directly related to the discharge diagnosis in 56.5 per cent of patients. Symptom-based discharge diagnoses were often associated with a malignancy not diagnosed on admission.ConclusionWhen analysed by subsequent cause of death, EGS is a cancer-based specialty. Adequate follow-up and close links with oncology and palliative care services merit development.

Highlights

A substantial number of patients treated in emergency general surgery (EGS) services die within a year of discharge
Emergency general surgery (EGS) comprises the unscheduled inhospital treatment of patients under the care of a surgeon with training in gastrointestinal surgery[1,2,3,4,5,6], and an important part of the spectrum of care provided by general surgeons[7,8]
The present study demonstrated that nearly half of patients who died within a year of discharge following an EGS admission succumbed to neoplastic disease

Summary

Introduction

Emergency general surgery (EGS) comprises the unscheduled inhospital treatment of patients under the care of a surgeon with training in gastrointestinal surgery[1,2,3,4,5,6], and an important part of the spectrum of care provided by general surgeons[7,8]. In Scotland, 35 per cent of patients aged 75 years and older, who were admitted as an emergency under the care of a general surgeon, died within 1 year of discharge, a figure that almost doubled when severe co-morbidities were present[3]. The aim of this study was to analyse causes of death and their relationship to discharge diagnoses, in patients who died within 1 year of discharge from an EGS service in Scotland. Results: Of 507 308 patients admitted to EGS services, 7917 died while in hospital, and 52 094 within 1 year of discharge. For the latter, the median survival time was 67 (i.q.r. 21–168) days after EGS discharge. Adequate follow-up and close links with oncology and palliative care services merit development

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