Population-level trends in emergency general surgery presentations and mortality over time.

Abstract

Emergency general surgery (EGS) refers to the treatment of a subset of general surgical disease necessitating emergency evaluation and management (operative or non-operative)1. The majority of these disorders relate to the abdomen and gastrointestinal tract, with a range of severity. Operations for EGS conditions have higher rates of perioperative complications and death than comparable elective procedures, and many of these deaths are thought to be preventable2,3. There are limited population-level data regarding the impact of EGS. Existing studies4–6 suggest a trend towards decreased mortality with time. Many of these studies relied on incomplete population data that were weighted to estimate more comprehensive regional or national information5,6. Additionally, previous evaluations were largely limited to admitted patients. Emergency department (ED) overcrowding is a worsening public health problem, with potential effects on timely access to care and clinical outcomes7. Patients may be diverted to outpatient surgery, develop complications that change their admitting diagnosis, or even die. Therefore, evaluating EGS-related ED presentations and management even without admission is important. The contribution of individual EGS diagnoses to overall trends in ED presentations, admissions, and mortality is also largely unexplored, yet this information will be essential in anticipating the future needs of the EGS workforce and associated distribution of resources. The objective of this study was to determine the population-level trends in ED presentations, hospital admissions, and mortality from EGS conditions over 17 years in Ontario, Canada.