Implementation of an emergency abdominal surgery classification: A propensity score-weighted before-after study

Area of Science:

• Surgical Outcomes
• Healthcare Management
• Patient Safety

Background:

• Emergency abdominal surgery carries substantial risks of postoperative morbidity and mortality.
• A structured classification system can enhance surgical case prioritization, potentially reducing delays and complications.
• This study assessed the effectiveness of a local emergency abdominal surgery classification on patient outcomes.

Purpose of the Study:

• To evaluate the impact of a newly implemented classification system for emergency abdominal surgery.
• To determine if the classification reduces postoperative complications.
• To assess the effect on the timeliness of surgical intervention.

Main Methods:

• A before-and-after study design comparing two 6-month periods.
• Inclusion of 438 patients undergoing emergency abdominal surgery.
• Utilized propensity score-weighted analysis and inverse probability weighting (IPW) to adjust for confounders.
• Defined endpoint as major postoperative complications within 30 days.

Main Results:

• The post-implementation group showed significantly lower excess ideal time to surgery (iTTS) and fewer postoperative complications (respiratory, infectious, digestive, cardiac, acute kidney injury).
• Inverse probability weighting (IPW) analysis revealed a significant association between classification implementation and reduced risk of postoperative complications (RR 0.40).
• The p-value for the reduction in complications was < 0.001.

Conclusions:

• Implementation of an emergency abdominal surgery classification system is associated with reduced postoperative complications.
• The reduction in complications is likely attributed to decreased delays in surgical intervention.
• This classification system offers a promising strategy for improving patient safety in emergency surgical settings.