Twenty‐year study of in‐hospital and postdischarge mortality following emergency general surgical admission

BACKGROUND: Emergency general surgery (EGS) patients have a higher mortality than those having elective surgery. Few studies have investigated changes in EGS‐associated mortality over time or explored mortality rates after discharge. The aim of this study was to conduct a comprehensive, population‐based analysis of mortality in EGS patients over a 20‐year time frame. METHODS: This was a cross‐sectional study of all adult EGS admissions in Scotland between 1996 and 2015. Data were obtained from national records. Co‐morbidities were defined by Charlson Co‐morbidity Index, and operations were coded by OPCS‐4 classifications. Linear and multivariable logistic regression models were used to evaluate changes over time. RESULTS: Among 1 450 296 patients, the overall inpatient, 30‐day, 90‐day and 1‐year mortality rates were 1·8, 3·8, 6·4 and 12·5 per cent respectively. Mortality was influenced by age at admission, co‐morbidity, operation performed and date of admission (all P < 0·001), and improved with time on subgroup analysis by age, co‐morbidity and operation status. Medium‐term mortality was high: the 1‐year mortality rate in patients aged over 75 years was 35·6 per cent. The 1‐year mortality rate in highly co‐morbid patients decreased from 75·1 to 57·1 per cent over the time frame of the study (P < 0·001). CONCLUSION: Mortality after EGS in Scotland has reduced significantly over the past 20 years. This analysis of medium‐term mortality after EGS admission demonstrates strikingly high rates, and postdischarge death rates are higher than is currently appreciated.