Facility of Origin Predicts Mortality After Colonic Perforation.

Area of Science:

• Surgical outcomes research
• Patient safety and quality improvement
• Healthcare systems analysis

Background:

• Colonic perforation is a critical surgical emergency with significant mortality.
• Understanding factors influencing outcomes in emergent colonic perforation surgery is vital for improving patient care.
• Transitions of care, particularly from chronic care facilities, may impact patient outcomes.

Purpose of the Study:

• To investigate the association between nonclinical factors, specifically care transitions, and mortality in patients undergoing emergent surgery for colonic perforation.
• To identify patient and system-level factors associated with increased 30-day postoperative mortality after emergent colonic perforation surgery.

Main Methods:

• Analysis of the 2006-2015 American College of Surgeons National Surgical Quality Improvement Program database.
• Inclusion of adult patients undergoing emergent partial colectomy for perforated viscus (wound class III or IV).
• Logistic regression analysis to identify independent predictors of 30-day postoperative mortality.

Main Results:

• Out of 4705 patients, 17.9% experienced 30-day mortality.
• Transfer from a chronic care facility was independently associated with increased mortality (OR 1.87, P < .0001).
• Septic shock, sepsis, and increased time from admission to surgery also independently predicted higher mortality.

Conclusions:

• Transfer from a chronic care facility is a significant independent risk factor for mortality in patients undergoing emergent surgery for perforated viscus.
• These findings underscore the need for improved care coordination and risk assessment for patients transitioning from chronic care settings to acute surgical care.