Browsing by Author "Vogt, Kelly N."

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    The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes : A Multicenter Validation Study
    (Lippincott, Williams & Wilkins, 2020-04-01) Savage, Stephanie A.; Li, Shi Wen; Utter, Garth H.; Cox, Jessica A.; Wydo, Salina M.; Cahill, Kevin; Sarani, Babak; Holzmacher, Jeremy; Duane, Therese M.; Gandhi, Rajesh R.; Zielinski, Martin D.; Ray-Zack, Mohamed; Tierney, Joshua; Chapin, Trinette; Murphy, Patrick B.; Vogt, Kelly N.; Schroeppel, Thomas J.; Callaghan, Emma; Kobayashi, Leslie; Coimbra, Raul; Schuster, Kevin M.; Gillaspie, Devin; Timsina, Lava; Louis, Alvancin; Crandall, Marie; Medicine, School of Medicine
    Introduction: Over the last five years, the American Association for the Surgery of Trauma (AAST) has developed grading scales for Emergency General Surgery (EGS) diseases. In a prior validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay and mortality in skin and soft tissue infections (STI). Methods: This multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics and outcomes such as mortality, overall complications, hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability. Results: 1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher LRINEC scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status and hospital-level volume. Grade V disease was significantly associated with mortality as well. Conclusion: This validation effort demonstrates that Grade IV and V STI are significantly predictive of complications, hospital length of stay and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process, in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.
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    Failure to rescue in emergency general surgery in Canada
    (Canadian Medical Association, 2022-03-22) Minor, Samuel; Allen, Laura; Meschino, Michael T.; Nenshi, Rahima; van Heest, Rardi; Saleh, Fady; Widder, Sandy; Engels, Paul T.; Joos, Emilie; Parry, Neil G.; Murphy, Patrick B.; Ball, Chad G.; Hameed, Morad; Vogt, Kelly N.; Canadian Collaborative on Urgent Care Surgery; Surgery, School of Medicine
    Background: The risk of death after a postoperative complication - known as failure to rescue (FTR) - has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres. Methods: In this multicentre retrospective cohort study, we performed a secondary analysis of data from a previous study designed to evaluate operative intervention for nonappendiceal, nonbiliary disease by 6 EGS services across Canada (1 in British Columbia, 1 in Alberta, 3 in Ontario and 1 in Nova Scotia). Patients underwent surgery between Jan. 1 and Dec. 31, 2014. We conducted univariate analyses to compare patients with and without complications. We performed a sensitivity analysis examining the mortality rate after serious complications (Clavien-Dindo score 3 or 4) that required a surgical intervention or specialized care (e.g., admission to intensive care unit). Results: A total of 2595 patients were included in the study cohort. Of the 206 patients who died within 30 days, 145 (70.4%) experienced a complication before their death. Overall, the mortality rate after any surgical complication (i.e., FTR) was 16.0%. Ranking of sites by the traditional outcomes of complication and mortality rates differed from the ranking when FTR rate was included in the assessment. Conclusion: There was variability in FTR rates across EGS services in Canada, which suggests that there is opportunity for ongoing quality-improvement efforts. This study provides FTR benchmarking data for Canadian EGS services.