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GI Surgical Emergencies: Scope and Burden of Disease

  • Evidence-Based Current Surgical Practice
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Nearly 3 million patients are hospitalized every year for emergent gastrointestinal (GI) surgical problems and nearly one third of those will require surgery. This article reviews the scope of GI surgical emergencies within the context of emergency general surgery (EGS), costs of care, overview of several common GI surgical problems, and traditional and emerging treatment modalities. This article also argues for ongoing work in the area of risk assessment for EGS, and describes quality metrics as well as outcomes of care for these patients.

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Author information

Authors and Affiliations

  1. Mayo Clinic, Rochester, MN, USA

    Matthew C. Hernandez

  2. University of Florida College of Medicine Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA

    Firas Madbak, Katherine Parikh & Marie Crandall

Authors
  1. Matthew C. Hernandez
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  2. Firas Madbak
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  3. Katherine Parikh
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  4. Marie Crandall
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Corresponding author

Correspondence to Marie Crandall.

Additional information

Disclosure Information

Authors: Matthew C. Hernandez, MD, has nothing to disclose; Firas Madbak, MD, has nothing to disclose; Katherine Parikh, DO, has nothing to disclose; Y. Marie Crandall, MD, PhD, has nothing to disclose. Editors-in-Chief: Richard A. Hodin, M.D. and Timothy M. Pawlik, MD, MPH, PhD, has nothing to disclose. CME Overseers: Arbiter: Timothy M. Pawlik, MD, MPH, PhD, has nothing to disclose; Vice-Arbiter: Melanie Morris, MD, has nothing to disclose; Question Reviewers: Melanie Morris, MD, has nothing to disclose; Uretz Oliphant, MD, has nothing to disclose.

CME questions for this article are available to SSAT members at http://ssat.com/jogscme/.

CME/MOC Questions

1. Emergency general surgery is defined as:

a. Non elective operation that is done to prevent mortality

b. An operation performed in the first 36 hours of hospital presentation

c. An operation declared as urgent by the anesthesiologist

d. Any operation performed during non standard operating time (ie nights and weekends)

2. Patients requiring emergency surgical intervention have been found to have all the following complications when compared to patients undergoing non emergent surgery EXCEPT:

a. Worse clinical status and overall outcome

b. Increased emotional and financial burden

c. Additional hospital costs

d. Shorter hospital length of stay

3. Seven operations have been identified as making up 80% of EGS cases. These include:

a. Total abdominal colectomy, small bowel resection and cholecystectomy

b. Appendectomy, Lysis of adhesions, small bowel resection

c. Laparotomy, total abdominal colectomy, appendectomy

d. Appendectomy, lysis of adhesions, hepatorrhaphy

4. Between 2001 to 2010, the number of hospital admissions for emergency surgery patients has increased. Which of the following has decreased?

a. The proportion of these patients requiring surgery

b. The associated number of patient deaths

c. The rates of patients with sepsis

d. The number of patients treated in non-teaching hospitals

5. When compared to nonemergent cases, postoperative morbidity was found to be significantly worse in the emergent group which included higher rates of all of the following EXCEPT :

a. Renal failure

b. Deep vein thrombosis

c. Ventilator requirement of more than 48 hours

d. Urinary tract infections

6. Which of the following has been found to be an independent predictor of morbidity in EGS patients:

a. Female sex

b. Lower transferrin levels

c. History of smoking

d. Increased blood glucose levels

7. Which of the following is true?

a. NSQIP has not successfully been used to measure and improve surgical care

b. Patients undergoing emergency operations have equivalent mortality to patients undergoing the same procedure electively

c. TQIP has shown minimal variation in risk adjusted outcomes for trauma patients

d. There is currently no EGS quality improvement program evaluating outcomes

8. Which of the following have been identified as factors discouraging surgeons to provide emergency coverage?

a. Abundance of surgeons providing emergency coverage

b. Reimbursement pressures

c. Appropriate monetary compensation for additional hours worked

d. Lack of operating time for additional cases

Learning Objectives

Learners will be able to identify the most common GI surgical emergencies.

Learners will be able to estimate the costs of care for GI surgical emergencies in the USA.

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Hernandez, M.C., Madbak, F., Parikh, K. et al. GI Surgical Emergencies: Scope and Burden of Disease. J Gastrointest Surg 23, 827–836 (2019). https://doi.org/10.1007/s11605-018-3992-6

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  • DOI: https://doi.org/10.1007/s11605-018-3992-6

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