BACKGROUND In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories. METHODS A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. RESULTS Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p < 0.001 for the interaction). CONCLUSION Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases.

中文翻译：

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急诊科住院时间与围手术期不良手术结果之间的关联：哥伦比亚大学两家医院的一项队列研究。

背景技术在低收入和中等收入国家，急诊手术在外科手术总数中所占比例较高，并且与较高的发病率/死亡率相关。研究目的是确定急诊科住院时间（ED-LOS）是否与不良围手术期结果相关，以及这种相关性是否因患者的风险类别而异。方法一项回顾性队列研究是对在哥伦比亚大学的两家医院接受了骨科或腹部急诊手术的成年患者进行的。人群包括合格病例的代表性样本与未选择的患者（2/3）的混合，其中富含高风险子集（1/3）。ED-LOS被定义为急诊科到达与手术开始时间之间的时间间隔。我们的主要结局是住院期间的不良围手术期结局，这是院内死亡率或严重并发症（例如主要的心血管不良事件，感染，肾衰竭和出血）的综合结果。结果在分析的1487例患者中，围手术期不良反应519例，其中150例死亡。在未选择的样本中（n = 998），有17.9％的患者围手术期结局不良，死亡率为4.9％。中位ED-LOS为24.6（IQR 12.5-53.2）小时。ED-LOS与年龄，合并症和已知的30天死亡率的危险因素有关。围手术期结局不良的患者比同行者晚27.1小时开始手术。ED-LOS延长会增加无危险因素的患者围手术期不良结局的风险（协变量调整后OR = 2.52），而具有1-2或3+的危险因素则呈负相关（OR分别为0.87和0.72，相互作用的p <0.001）。结论对于没有死亡危险因素的患者，延长的ED-LOS与围手术期不良结局增加相关，但对于较复杂的病例似乎具有保护性和医学上的合理性。