The 7 Deadliest Emergency General Surgeries | WPN World People News

Seven types of operations, including appendectomy and gall bladder removal, account for four out of five emergency general-surgery deaths in the United States, a new study reports.

The procedures are: partial removal of the large or small intestine; surgery to repair a bleeding or torn ulcer; separating abdominal organs that have adhered to each other; appendix removal; gall bladder removal; and open-abdominal surgery.

Researchers found these operations also account for 80 percent of complications from emergency general surgery, a specialty that focuses primarily on abdominal health problems.

"Our gastrointestinal tract is just so specialized and so critical to our existence. We think it's easy to operate on, but then in practice it's very difficult for patients," said expert. "We find that even patients who undergo open heart surgery can have better outcomes than patients that undergo open intestinal surgery."

In this study, the researchers looked at procedures that meet the definition of emergency general surgery as created by the American Association of Surgery for Trauma, he said. These mainly include operations to deal with gastrointestinal problems, soft tissue infections and hernias.

The researchers focused on emergency general surgery performed within two days of hospital admission due to a serious medical condition. Heart-related procedures and surgery prompted by traumatic events like car crashes were excluded from the analysis.

More than 3 million Americans undergo emergency general surgery every year, the expert said.

Emergency general surgery is inherently more risky because it is performed with little to no advance planning or preparation, on patients who are in dire straits, expert said. They typically are suffering from gastrointestinal bleeding, a bowel obstruction, or severe infections of the digestive tract.

As a result, people forced to undergo emergency surgery are up to eight times more likely to die following their operation than patients who undergo the same procedure on an elective basis, expert noted.

The researchers analyzed a government database of claims data involving more than 421,000 U.S. patients who underwent emergency general surgery between 2008 and 2011. They found an overall death rate of 1.2 percent and a complication rate of 15 percent. The average cost per hospital admission was $13,241, the researchers said.

Some of the top seven operations are simply very risky, particularly when performed on an emergency basis, said expert.

"Bowel resection [surgery to remove portions of the bowel] is probably, even as an elective procedure, considered a risky operation," said expert. "To do that under emergency circumstances when you don't have the benefit of a bowel that's been cleansed ahead of time, it sets the stage for some serious and expensive complications."

Expert agreed, noting that's likely why ulcer surgery ranked so high on the list.

On the other hand, procedures like appendectomy or gall bladder removal are very safe operations that made the list because they are done so often in the United States, expert said.

"Those each happen 600,000 times a year, so even a very small complication rate multiplied by that large number becomes costly," expert said.

Patients can reduce their risk of needing one of these surgeries by taking good care of their health -- for example, treating their ulcers with medication -- and by seeking prompt medical attention when they're not feeling well, expert said.

Surgeons can improve the safety of these emergency procedures by creating better protocols in advance, expert said.

Also, emergency general surgeons should be taught to have a "team huddle" during operations to discuss critical decisions with the rest of the surgical team, expert added.

Source: U.S. Dept. of Health & Human Services