Impact of deprivation and comorbidity on outcomes in emergency general surgery: an epidemiological study

Jared M Wohlgemut; George Ramsay; Russell L Griffin; Jan O Jansen

doi:10.1136/tsaco-2020-000500

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Figure 1
Flow diagram of included and excluded cases. EGS, emergency general surgery.

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Table 1

Demographics of all patients admitted for EGS in Scotland 1997 to 2016

All patient demographics			All	SIMD										CCI 5-Year
All patient demographics			All	1	2	3	4	5	6	7	8	9	10	0	1 to 2	3 to 4	>4
Age	All adults (>15)	All	1 468 238	237 824	195 889	176 224	162 909	149 591	136 094	123 954	108 515	95 408	81 830	1 116 808	299 657	37 558	23 787
		Male	700 479	116 647	92 473	82 535	76 969	71 196	65 167	59 775	51 870	45 249	38 598	521 238	151 804	21 938	11 334
		Female	767 759	121 177	103 416	93 689	85 940	78 395	70 927	64 179	56 645	50 159	43 232	595 570	147 853	15 620	12 453
	16–30	All	276 349	51 865	40 337	33 603	29 994	26 530	23 065	21 129	18 756	16 032	15 038	266 649	10 571	767	667
		Male	123 758	23 945	17 938	14 648	13 353	11 859	10 212	9573	8479	6973	6778	119 274	5214	347	314
		Female	152 591	27 920	22 399	18 955	16 641	14 671	12 853	11 556	10 277	9059	8260	147 375	5357	420	353
	31–45	All	308 175	59 724	45 061	37 280	32 749	29 232	25 604	23 477	21 735	18 593	14 720	277 158	28 330	3048	2219
		Male	146 279	30 514	21 622	17 586	15 353	13 717	11 995	10 765	9852	8200	6675	131 640	13 604	1749	1038
		Female	161 896	29 210	23 439	19 694	17 396	15 515	13 609	12 712	11 883	10 393	8045	145 518	14 726	1299	1181
	46–60	All	312 074	51 976	41 866	37 046	33 846	30 910	28 541	26 708	23 566	20 682	16 933	238 620	61 717	7887	6034
		Male	155 601	26 959	20 768	18 428	17 004	15 284	14 186	13 387	11 521	9961	8103	117 984	31 623	4657	2730
		Female	156 473	25 017	21 098	18 618	16 842	15 626	14 355	13 321	12 045	10 721	8830	120 636	30 094	3230	3304
	60–75	All	316 745	44 921	39 783	37 942	37 085	33 780	31 735	28 182	23 879	21 463	17 975	187 603	106 537	14 384	9853
		Male	165 470	23 329	20 272	19 278	19 107	17 781	16 857	15 165	12 821	11 471	9389	93 903	58 654	8819	5021
		Female	151 275	21 592	19 511	18 664	17 978	15 999	14 878	13 017	11 058	9992	8586	93 700	47 883	5565	4832
	>75	All	254 895	29 338	28 842	30 353	29 235	29 139	27 149	24 458	20 579	18 638	17 164	146 778	92 502	11 472	5014
		Male	109 371	11 900	11 873	12 595	12 152	12 555	11 917	10 885	9197	8644	7653	58 437	42 709	6366	2231
		Female	109 371	17 438	16 969	17 758	17 083	16 584	15 232	13 573	11 382	9994	9511	88 341	49 793	5106	2783
LOS	Total	Median	2	2	2	2	2	2	2	2	2	2	2	2	3	3	4
		25 Quartile	1	1	1	1	1	1	1	1	1	1	1	1	1	1	1
		75 Quartile	4	4	4	4	5	5	5	4	4	4	4	4	6	8	9
D/C Mortality		%	79%	80%	79%	78%	78%	78%	78%	78%	78%	78%	79%	83%	66%	59%	58%
	Inpatient	%	2%	2%	2%	2%	2%	2%	2%	2%	2%	2%	2%	1%	5%	6%	11%
	30-day	%	4%	3%	4%	4%	4%	4%	4%	4%	4%	4%	4%	2%	9%	13%	23%
	90-day	%	7%	7%	7%	8%	8%	8%	8%	8%	7%	7%	7%	3%	17%	23%	41%
	1-year	%	12%	12%	12%	13%	13%	13%	13%	13%	13%	13%	12%	8%	25%	32%	52%

CCI, Charlson Comorbidity Index; D/C, discharged home; LOS, length of hospital stay; n, number of admissions; SIMD, Scottish Index of Multiple Deprivation.

Table 2

Demographics of patients admitted for EGS in Scotland who underwent an operative procedure 1997 to 2016

Operative patient demographics			All	SIMD										CCI 5-Year
Operative patient demographics			All	1	2	3	4	5	6	7	8	9	10	0	1 to 2	3 to 4	>4
Age	All adults (>15)	All	395 234	55 368	49 924	47 274	44 052	40 949	37 547	34 271	31 420	28 386	26 043	299 344	82 146	9673	6312
		Male	196 185	27 893	24 373	23 167	21 496	20 283	18 499	17 374	15 718	14 229	13 153	146 621	42 312	5666	2931
		Female	199 049	27 475	25 551	24 107	22 556	20 666	19 048	16 897	15 702	14 157	12 890	152 723	39 834	4007	3381
	16–30	All	78 751	12 898	10 884	9410	8473	7614	6807	6308	5900	5279	5178	75 732	3298	194	135
		Male	39 697	6698	5426	4610	4262	3780	3350	3181	3025	2683	2682	38 167	1759	91	65
		Female	39 054	6200	5458	4800	4211	3834	3457	3127	2875	2596	2496	37 565	1539	103	70
	31–45	All	82 907	13 715	11 476	10 079	8964	8036	7204	6543	6306	5734	4850	74 677	7533	780	486
		Male	41 612	7087	5658	4954	4454	4146	3597	3294	3123	2818	2481	37 457	3857	458	221
		Female	41 295	6628	5818	5125	4510	3890	3607	3249	3183	2916	2369	37 220	3676	322	265
	46–60	All	82 405	11 641	10 281	9791	8847	8265	7879	7398	6747	6069	5487	62 268	16 913	2090	1622
		Male	42 352	6095	5194	5119	4522	4181	3959	3913	3445	3091	2833	31 483	9145	1273	746
		Female	40 053	5546	5087	4672	4325	4084	3920	3485	3302	2978	2654	30 785	7768	817	876
	60–75	All	86 349	10 616	10 286	10 285	10 164	9529	8799	7939	6934	6274	5523	50 063	30 104	3776	2771
		Male	44 967	5424	5194	5226	5194	5013	4645	4251	3702	3378	2940	24 906	16 545	2346	1368
		Female	41 382	5192	5092	5059	4970	4516	4154	3688	3232	2896	2583	25 157	13 559	1430	1403
	>75	All	64 822	6498	6997	7709	7604	7505	6858	6083	5533	5030	5005	36 604	24 298	2833	1298
		Male	27 557	2589	2901	3258	3064	3163	2948	2735	2423	2259	2217	14 608	11 006	1498	531
		Female	37 265	3909	4096	4451	4540	4342	3910	3348	3110	2771	2788	21 996	13 292	1335	767
LOS	Total	Median	3	3	3	3	3	3	3	3	3	3	3	3	4	4	6
		25 Quartile	1	1	1	1	1	1	1	1	1	1	1	1	2	2	2
		75 Quartile	6	6	6	6	6	6	6	6	6	6	6	5	9	9	14
D/C Mortality		%	81%	82%	81%	80%	80%	80%	80%	80%	80%	80%	81%	86%	66%	58%	61%
	Inpatient	%	1%	1%	1%	1%	1%	1%	1%	1%	1%	1%	1%	0%	3%	5%	10%
	30 day	%	3%	3%	3%	4%	3%	3%	3%	3%	3%	3%	3%	1%	8%	12%	20%
	90 day	%	7%	7%	7%	7%	7%	7%	7%	7%	6%	7%	6%	3%	16%	22%	41%
	1 year	%	13%	11%	11%	12%	12%	12%	12%	12%	11%	11%	11%	7%	23%	32%	52%

CCI, Charlson Comorbidity Index; D/C, discharged home; LOS, length of hospital stay; n, number of admissions; SIMD, Scottish Index of Multiple Deprivation.

Table 3

Logistic regression analyses for discharge home and inpatient, 30-day, 90-day and 1-year mortality

Logistic regression analysis	Parameter	Age	Male	SIMD 1	SIMD 2	SIMD 3	SIMD 4	SIMD 5	SIMD 6	SIMD 7	SIMD 8	SIMD 9	CCI 1 to 2	CCI 3 to 4	CCI >4
All patients
Discharge home	OR	0.98	0.95	0.97	0.97	0.95	0.96	0.95	0.98	0.98	0.97	0.97	0.57	0.43	0.38
	Lower 95% CI	0.98	0.94	0.95	0.95	0.93	0.94	0.93	0.95	0.96	0.95	0.95	0.57	0.42	0.37
	Upper 95% CI	0.98	0.96	0.99	0.99	0.97	0.98	0.97	1.00	1.01	0.99	0.99	0.58	0.44	0.39
Inpatient mortality	OR	1.07	0.95	1.36	1.41	1.30	1.24	1.16	1.13	1.16	1.15	1.09	3.95	5.56	13.74
	Lower 95% CI	1.07	0.92	1.28	1.32	1.21	1.16	1.08	1.05	1.08	1.07	1.01	3.83	5.29	13.09
	Upper 95% CI	1.07	0.97	1.46	1.50	1.39	1.33	1.24	1.21	1.24	1.24	1.18	4.07	5.84	14.42
30-day mortality	OR	1.06	1.07	1.28	1.27	1.24	1.15	1.14	1.10	1.11	1.11	1.05	3.79	5.54	14.09
	Lower 95% CI	1.06	1.05	1.22	1.21	1.18	1.10	1.09	1.05	1.06	1.05	1.00	3.72	5.35	13.59
	Upper 95% CI	1.06	1.09	1.34	1.33	1.30	1.21	1.20	1.16	1.17	1.16	1.11	3.87	5.73	14.59
90-day mortality	OR	1.05	1.05	1.19	1.20	1.17	1.11	1.09	1.08	1.09	1.08	1.08	3.48	5.09	14.68
	Lower 95% CI	1.05	1.04	1.15	1.16	1.13	1.08	1.05	1.04	1.05	1.04	1.04	3.43	4.95	14.26
	Upper 95% CI	1.05	1.06	1.23	1.24	1.21	1.15	1.13	1.12	1.13	1.12	1.12	3.54	5.23	15.11
1-year mortality	OR	1.03	1.00	1.11	1.11	1.09	1.06	1.04	1.04	1.03	1.04	1.07	2.61	3.78	9.85
	Lower 95% CI	1.03	0.99	1.08	1.08	1.06	1.03	1.01	1.01	1.01	1.01	1.04	2.58	3.70	9.59
	Upper 95% CI	1.03	1.01	1.14	1.14	1.12	1.08	1.07	1.07	1.06	1.07	1.10	2.64	3.87	10.12
Operative patients
Discharge home	OR	0.97	1.00	0.92	0.96	0.95	0.96	0.95	0.99	0.97	0.96	0.95	0.49	0.36	0.37
	Lower 95% CI	0.97	0.98	0.89	0.92	0.91	0.93	0.91	0.95	0.93	0.92	0.91	0.48	0.34	0.35
	Upper 95% CI	0.97	1.02	0.96	1.00	0.99	1.00	0.99	1.03	1.01	1.00	1.00	0.50	0.37	0.39
Inpatient mortality	OR	1.07	0.97	1.62	1.55	1.41	1.36	1.30	1.08	1.27	1.16	1.13	3.85	5.60	15.21
	Lower 95% CI	1.06	0.92	1.41	1.34	1.22	1.17	1.12	0.92	1.09	0.99	0.96	3.60	5.01	13.75
	Upper 95% CI	1.07	1.03	1.87	1.79	1.63	1.57	1.50	1.26	1.48	1.36	1.33	4.12	6.25	16.82
30-day mortality	OR	1.06	1.09	1.53	1.40	1.38	1.21	1.18	1.13	1.18	1.11	1.11	3.37	5.26	12.16
	Lower 95% CI	1.06	1.05	1.39	1.28	1.25	1.10	1.07	1.02	1.07	1.00	1.00	3.24	4.90	11.31
	Upper 95% CI	1.06	1.13	1.68	1.54	1.51	1.33	1.30	1.25	1.31	1.23	1.24	3.52	5.65	13.06
90-day mortality	OR	1.05	1.07	1.33	1.28	1.26	1.14	1.14	1.11	1.12	1.08	1.10	3.51	5.28	15.46
	Lower 95% CI	1.05	1.04	1.25	1.20	1.18	1.06	1.06	1.04	1.05	1.00	1.02	3.41	5.00	14.61
	Upper 95% CI	1.05	1.10	1.42	1.37	1.34	1.21	1.22	1.19	1.20	1.16	1.19	3.61	5.57	16.35
1-year mortality	OR	1.03	1.06	1.22	1.18	1.14	1.09	1.09	1.09	1.08	1.06	1.09	2.82	4.25	11.21
	Lower 95% CI	1.03	1.04	1.16	1.12	1.08	1.03	1.03	1.03	1.02	1.00	1.03	2.76	4.05	10.64
	Upper 95% CI	1.03	1.08	1.28	1.24	1.20	1.15	1.14	1.15	1.14	1.12	1.15	2.89	4.45	11.82

SIMD, Scottish Index of Multiple Deprivation; CCI, Charlson Comorbidity Index.

Table 4

Poisson regression analyses for length of hospital stay

Poisson analysis	Parameter	Male	SIMD 1	SIMD 2	SIMD 3	SIMD 4	SIMD 5	SIMD 6	SIMD 7	SIMD 8	SIMD 9	Age	CCI 1 to 2	CCI 3 to 4	CCI >4
All patients	OR	0.87	1.11	1.10	1.10	1.10	1.08	1.08	1.07	1.06	1.03	1.02	1.35	1.51	1.69
	Lower 95% CI	0.87	1.11	1.09	1.10	1.09	1.08	1.07	1.06	1.05	1.02	1.02	1.35	1.51	1.68
	Upper 95% CI	0.87	1.12	1.10	1.10	1.10	1.09	1.08	1.07	1.06	1.03	1.02	1.36	1.52	1.69
Operative patients	OR	0.85	1.13	1.08	1.08	1.06	1.06	1.07	1.06	1.03	1.03	1.02	1.32	1.35	1.71
	Lower 95% CI	0.85	1.12	1.08	1.07	1.05	1.05	1.06	1.06	1.02	1.02	1.02	1.31	1.34	1.70
	Upper 95% CI	0.86	1.14	1.09	1.09	1.07	1.06	1.07	1.07	1.03	1.04	1.02	1.32	1.36	1.73

Reference variables: Female; SIMD 10; CCI 0.
CCI, Charlson Comorbidity Index; SIMD, Scottish Index of Multiple Deprivation.