Biomedical

Time-to-surgery paradigms: wait time and surgical outcomes in critically Ill patients who underwent emergency surgery for gastrointestinal perforation



  Peer Reviewed

Abstract

Background

Waiting time for emergency abdominal surgery has been known to be linked to mortality. However, there is no clear consensus on the appropriate timing of surgery for gastrointestinal perforation. We investigated the association between wait time and surgical outcomes in emergency abdominal surgery.

Methods

This single-center retrospective cohort study evaluated adult patients who underwent emergency surgery for gastrointestinal perforations between January 2003 and September 2021. Risk-adjusted restricted cubic splines modeled the probability of each mortality according to wait time. The inflection point when mortality began to increase was used to define early and late surgery. Outcomes among propensity-score matched early and late surgical patients were compared using percent absolute risk differences (RDs, with 95% CIs).

Results

Mortality rates began to rise after 16 hours of waiting. However, early and late surgery groups showed no significant differences in 30-day mortality (11.4% vs. 5.7%), ICU stay duration (4.3 ± 7.5 vs. 4.3 ± 5.2 days), or total hospital stay (17.4 ± 17.0 vs. 24.7 ± 23.4 days). Notably, patients waiting over 16 hours had a significantly higher ICU readmission rate (8.6% vs. 31.4%). The APACHE II score was a significant predictor of 30-day mortality.

Conclusions

Although we were unable to reveal significant differences in mortality in the subgroup analysis, we identified an inflection point of 16 hours through the RCS curve technique.

Key Questions

1. How does wait time affect outcomes in emergency gastrointestinal perforation surgeries?

Mortality rates increase after 16 hours of waiting for surgery, indicating that delays can adversely affect patient outcomes.

2. What is the optimal time frame for performing surgery on gastrointestinal perforations?

The study suggests that performing surgery within 16 hours may reduce mortality and improve patient outcomes.

3. Does delaying surgery beyond 16 hours impact ICU readmission rates?

Yes, patients who waited more than 16 hours for surgery had a significantly higher ICU readmission rate (31.4%) compared to those who had surgery earlier (8.6%).

4. Are there differences in 30-day mortality between early and late surgery groups?

The study found no significant differences in 30-day mortality between early (11.4%) and late (5.7%) surgery groups.

5. What factors predict 30-day mortality in patients undergoing emergency surgery for gastrointestinal perforation?

The APACHE II score was identified as a significant predictor of 30-day mortality in these patients.