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

Emergency abdominal surgery is associated with high rates of postoperative morbidity and mortality. A structured classification system for emergency surgery may help prioritize cases more effectively, reducing delays to the operating room and postoperative complications. This study evaluates the impact of a locally implemented classification for emergency abdominal surgery on postoperative complications.

A before-and-after study was conducted in a University Hospital and included patients undergoing emergency abdominal surgery over two 6-month periods: before (September 2019 to March 2020) and after (June 2023 to December 2023) the implementation of a surgical emergency classification. The classification, developed by a panel of local experts, assigned an ideal time to surgery (iTTS) based on five urgency grades. Propensity score-weighted analysis was used to adjust for confounding factors. The endpoint was the occurrence of major postoperative complications within 30 days.

A total of 438 patients were analyzed (219 before and 219 after implementation). Excess iTTS measured by the actual time to surgery (aTTS)/iTTS ratio and postoperative complications (respiratory, infectious, digestive, cardiac) as well as acute kidney injury were significantly lower in the post-implementation group (p <  0.05). After inverse probability weighting (IPW), the risk of postoperative complications was significantly associated with the implementation of classification, with a relative risk of 0.40 [95% CI, 0.19-0.85], P < 0.001.

This study shows that the implementation of a classification of emergency abdominal surgery could reduce the rate of postoperative complications probably by reducing the delay to surgery.