64.16 Emergency Upper GI Surgery in the United States: Burden of Disease and Ten-year trend – 2001-2010

Posted on December 22, 2014

J. S. Crystal1, V. Y. Dombrovskiy1, S. C. Gale1,2  1Robert Wood Johnson – Rutgers,Surgery,New Brunswick, NJ, USA 2East Texas Medical Center,Surgery,Tyler, TX, USA

Introduction:

Upper gastrointestinal (UGI) disorders, including peptic ulcer disease, are most commonly managed medically, yet patients presenting with emergent UGI conditions often require surgical evaluation and operative intervention. Using a large national database, we sought to assess the “burden of disease” for emergent presentation of UGI disorders and the need for surgical intervention during admission, over a ten-year period. 

Methods:
The Nationwide Inpatient Sample from 2001-2010 was queried for all patients admitted with emergent surgical illness (EGS) as recently defined by the AAST. The study population was selected using UGI-specific ICD-9 diagnosis and procedure codes and limited to patients admitted with urgent or emergent status. Operative rates, mortality, sepsis, and demographics were compiled. T-test and Cochran-Armitage trend test were used; p< 0.05 was significant.

Results:
During the 10-year study period 4,626,204 patients were admitted emergently to US hospitals with UGI disorders.  The average age was 64.7 years; 56% were female.  From 2000 to 2010, UGI admissions decreased as a percentage of total EGS (18.7% to 14.9%; p<0.0001) and while sepsis rates increased from 1.8% to 2.2% (p<0.0001), mortality declined from 2.6% to 1.6% (p<0.0001). During the study period, surgical rates increased markedly from 20.2% to 38.4% (p<0.0001) with a total of 1,438,649 patients (31.1%) requiring surgery. 

Conclusion:
While overall emergent admissions for UGI disorders have declined, surgical rates have increased significantly for those patients admitted. Although more patients present with sepsis, mortality has declined which may reflect improving critical care. These data suggest that general and acute care surgeons should address this growing emergent UGI disease burden with renewed emphasis on gastroduodenal procedures during surgical training and with future prospective inquiry.