Surgical rescue: The next pillar of acute care surgery

Matthew E. Kutcher; Jason L. Sperry; Matthew R. Rosengart; Deepika Mohan; Marcus K. Hoffman; Matthew D. Neal; Louis H. Alarcon; Gregory A. Watson; Juan Carlos Puyana; Graciela M. Bauzá; Vaishali D. Schuchert; Anisleidy Fombona; Tianhua Zhou; Samuel J. Zolin; Robert D. Becher; Timothy R. Billiar; Raquel M. Forsythe; Brian S. Zuckerbraun; Andrew B. Peitzman

doi:10.1097/TA.0000000000001312

Surgical rescue: The next pillar of acute care surgery

Matthew E. Kutcher, Jason L. Sperry, Matthew R. Rosengart, Deepika Mohan, Marcus K. Hoffman, Matthew D. Neal, Louis H. Alarcon, Gregory A. Watson, Juan Carlos Puyana, Graciela M. Bauzá, Vaishali D. Schuchert, Anisleidy Fombona, Tianhua Zhou, Samuel J. Zolin, Robert D. Becher, Timothy R. Billiar, Raquel M. Forsythe, Brian S. Zuckerbraun, Andrew B. Peitzman

Section of Acute and Critical Care Surgery

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

BACKGROUND: The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. METHODS: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. RESULTS: Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. CONCLUSION: We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications.

Original language	English
Pages (from-to)	280-286
Number of pages	7
Journal	Journal of Trauma and Acute Care Surgery
Volume	82
Issue number	2
DOIs	https://doi.org/10.1097/TA.0000000000001312
State	Published - Feb 1 2017

Keywords

Failure to rescue
acute care surgery
complication

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10.1097/TA.0000000000001312

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Kutcher, M. E., Sperry, J. L., Rosengart, M. R., Mohan, D., Hoffman, M. K., Neal, M. D., Alarcon, L. H., Watson, G. A., Puyana, J. C., Bauzá, G. M., Schuchert, V. D., Fombona, A., Zhou, T., Zolin, S. J., Becher, R. D., Billiar, T. R., Forsythe, R. M., Zuckerbraun, B. S., & Peitzman, A. B. (2017). Surgical rescue: The next pillar of acute care surgery. Journal of Trauma and Acute Care Surgery, 82(2), 280-286. https://doi.org/10.1097/TA.0000000000001312

@article{3fbf5386f0e14bb38787a93f1aaa502c,

title = "Surgical rescue: The next pillar of acute care surgery",

abstract = "BACKGROUND: The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of {"}surgical rescue{"} in the practice of ACS. METHODS: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. RESULTS: Of 2,410 ACS patients, 320 (13%) required {"}surgical rescue{"}: most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ({"}local{"}), whereas 38% were referred from another surgical service ({"}institutional{"}) and 26% referred from another institution ({"}regional{"}). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between {"}local{"} and {"}institutional{"} patients, but hospital length of stay and discharge to home were significantly worse in {"}institutional{"} referrals. CONCLUSION: We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the {"}surgical rescue{"} of surgical and procedural complications.",

keywords = "Failure to rescue, acute care surgery, complication",

author = "Kutcher, {Matthew E.} and Sperry, {Jason L.} and Rosengart, {Matthew R.} and Deepika Mohan and Hoffman, {Marcus K.} and Neal, {Matthew D.} and Alarcon, {Louis H.} and Watson, {Gregory A.} and Puyana, {Juan Carlos} and Bauz{\'a}, {Graciela M.} and Schuchert, {Vaishali D.} and Anisleidy Fombona and Tianhua Zhou and Zolin, {Samuel J.} and Becher, {Robert D.} and Billiar, {Timothy R.} and Forsythe, {Raquel M.} and Zuckerbraun, {Brian S.} and Peitzman, {Andrew B.}",

year = "2017",

month = feb,

day = "1",

doi = "10.1097/TA.0000000000001312",

language = "English",

volume = "82",

pages = "280--286",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

number = "2",

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Kutcher, ME, Sperry, JL, Rosengart, MR, Mohan, D, Hoffman, MK, Neal, MD, Alarcon, LH, Watson, GA, Puyana, JC, Bauzá, GM, Schuchert, VD, Fombona, A, Zhou, T, Zolin, SJ, Becher, RD, Billiar, TR, Forsythe, RM, Zuckerbraun, BS & Peitzman, AB 2017, 'Surgical rescue: The next pillar of acute care surgery', Journal of Trauma and Acute Care Surgery, vol. 82, no. 2, pp. 280-286. https://doi.org/10.1097/TA.0000000000001312

TY - JOUR

T1 - Surgical rescue

T2 - The next pillar of acute care surgery

AU - Kutcher, Matthew E.

AU - Sperry, Jason L.

AU - Rosengart, Matthew R.

AU - Mohan, Deepika

AU - Hoffman, Marcus K.

AU - Neal, Matthew D.

AU - Alarcon, Louis H.

AU - Watson, Gregory A.

AU - Puyana, Juan Carlos

AU - Bauzá, Graciela M.

AU - Schuchert, Vaishali D.

AU - Fombona, Anisleidy

AU - Zhou, Tianhua

AU - Zolin, Samuel J.

AU - Becher, Robert D.

AU - Billiar, Timothy R.

AU - Forsythe, Raquel M.

AU - Zuckerbraun, Brian S.

AU - Peitzman, Andrew B.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - BACKGROUND: The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. METHODS: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. RESULTS: Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. CONCLUSION: We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications.

AB - BACKGROUND: The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. METHODS: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. RESULTS: Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. CONCLUSION: We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications.

KW - Failure to rescue

KW - acute care surgery

KW - complication

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U2 - 10.1097/TA.0000000000001312

DO - 10.1097/TA.0000000000001312

M3 - Article

C2 - 27893639

AN - SCOPUS:84997822241

SN - 2163-0755

VL - 82

SP - 280

EP - 286

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 2

ER -

Surgical rescue: The next pillar of acute care surgery

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Keywords

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