Developing a toolbox for identifying when to engage senior surgeons in emergency general surgery: A multicenter...

Area of Science:

• Surgical Safety
• Health Services Research
• Clinical Decision Support

Background:

• Senior surgeon presence is crucial for high-risk emergency surgery, but 24-hour consultant cover is inefficient.
• A user-friendly toolbox was developed for risk identification, outcome prediction, and patient stratification to guide senior surgeon involvement.

Purpose of the Study:

• To develop and validate a risk assessment tool for optimizing senior surgeon allocation in emergency general surgery.
• To improve patient safety and resource efficiency in emergency surgical care.

Main Methods:

• A multicenter prospective cohort study included 11,901 general surgery patients in China (2015-2016).
• Risk indicators were identified and evaluated by 48 experienced surgeons.
• Logistic regression models predicted mortality and morbidity; an Acute Call Team (ACT) model stratified patients.

Main Results:

• Emergency patients faced higher mortality (3.6% vs 0.6%) and morbidity (7.8% vs 4.3%) risks with less senior surgeon presence (59.9% vs 91.4%).
• A three-indicator model accurately predicted emergency mortality (C-statistic 0.90).
• The ACT model stratified patients, with low-risk groups having 0.5% mortality and 5.3% morbidity, and very high-risk groups having 15.9% mortality and 29.0% morbidity.

Conclusions:

• The developed risk assessment tool is practically feasible for directing senior surgeon involvement in emergency general surgery.
• This approach supports efficient and targeted deployment of surgical expertise, enhancing patient safety.