Photo Credit: Pornpak Khunatorn
The following is a summary of “Operative and Nonoperative Outcomes of Emergency General Surgery Conditions,” published in the July 2023 issue of Surgery by Kaufman et al.
To assess the impact of surgical versus non-surgical intervention in managing acute general surgical conditions on immediate and long-term clinical outcomes. Numerous emergency general surgical conditions may be effectively governed through operative or nonoperative means; however, substantial evidence to inform decision-making regarding management is limited. Researchers enrolled 507,677 Medicare beneficiaries who received medical care for an emergency general surgery condition from July 1, 2015, to June 30, 2018. The comparison was made between operative and nonoperative management using a preference-based instrumental variable analysis and near-far matching technique to reduce the impact of selection bias and unmeasured confounding.
The observed outcomes encompassed mortality, complications, and readmissions. In cases of hepatopancreatic biliary conditions, surgical intervention demonstrated a reduced mortality risk within 30 days [-2.6% (95% CI: -4.0, -1.3)], 90 days [-4.7% (-6.50, -2.8)], and 180 days [-6.4% (-8.5, -4.2)]. Among a cohort of 56,582 patients diagnosed with intestinal obstruction, it was observed that surgical intervention was linked to an increased mortality risk during the hospital stay, with a rate of 2.8% (0.7, 4.9). However, no statistically significant difference was found in mortality rates beyond the inpatient period. For upper gastrointestinal disorders, surgical intervention was found to have a 9.7% elevated mortality risk during the patient’s hospital stay (6.4, 13.1), with this risk progressively increasing as time passed. There was a 6.9% high risk of mortality among patients admitted to the hospital (3.6, 10.2) when undergoing surgical intervention for colorectal conditions, and this risk showed a progressive increase as time passed.
For general abdominal conditions, surgical intervention was correlated with a 12.2% higher likelihood of mortality during hospitalization (8.7, 15.8). This effect was reduced at 30 days [8.5% (3.8, 13.2)] and not statistically significant afterward. The impact of surgical intervention for emergency general surgery management exhibited variability among different medical conditions and demonstrated temporal fluctuations. Nonoperative management yields better outcomes for patients with colorectal and upper gastrointestinal disorders, while surgery is the preferred approach for those with hepatopancreatic biliary conditions. For cases of obstructions and general abdominal conditions, the overall outcomes were found to be comparable. These findings support patients, healthcare professionals, and families when making difficult medical decisions.
