ACUTE-Acute Surgical Care- Risk Factors and Outcomes for Patients in Need of Acute Surgical Care

Study Overview
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Brief Summary
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Observational retrospective study of patients in need of acute surgical care admitted to Skåne University Hospital between 2009 and 2019.

Detailed Description
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At Skåne University Hospital approximately 6000 individuals are treated for acute abdominal diseases each year. Given the high number of patients, there is an urgent need to optimize acute surgical care. Lower complication rates would decrease hospital stay, health care costs as well as personal suffering. Assessment instruments for risks and frailty are not validated for the acute setting and the investigators hypothesize there is room for improvement in prophylactic interventions and risk assessment. The investigators will study cohorts of patients with three different surgical diagnosis: acute pancreatitis, gastrointestinal bleeding and perforated ulcer aiming to identify risk factors for complications or death and to investigate assessment tools in this population. Using propensity score analysis, the investigators will try to identify treatment options associated with better outcome for subcohorts defined by frailty, comorbidity, age or gender. Specific factors of interest include: time to- and kind of treatment, handling of ongoing pharmacological therapy (anticoagulants, corticosteroids) and need for further treatments on a long time basis. The results from this project will be used in a future prospective study where prophylactic treatments and specific treatment options are studied.

Official Title
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ACUTE-Acute Surgical Care- Risk Factors and Outcomes for Patients in Need of Acute Surgical Care

Conditions
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Risk Factors, Complication of Surgical Procedure, Complication of Treatment, Complication of Anesthesia, Long Term Effects After Emergency Surgery, Long Term Effects After GI Bleeding

Intervention / Treatment
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* Other: Observational study of different treatments and time to treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients admitted to Skåne University hospital in need of acute surgical care - Exclusion Criteria: Below 18 years old -

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mild acute pancreatitis<br>Patients treated with mild acute pancreatitis during the study period | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Moderate acute pancreatitis<br>Patients treated with moderate acute pancreatitis during the study period | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Severe acute pancreatitis<br>Patients treated with severe acute pancreatitis during the study period | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Acute gastrointestinal bleeding<br>Patients treated with acute gastrointestinal bleeding during the study period | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Perforated ulcer<br>Patients treated with perforated ulcer during the study period | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Older than 70 years<br>Patients older than 70 years | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Less than 70 years<br>Patients younger than 70 years | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Prothrombotic medications<br>Patients on prothrombotic medications | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Frail patients<br>Patients with increased frailty score | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|
| Reintervention group<br>Patients in need of reintervention | Other: Observational study of different treatments and time to treatment<br>* Different treatment based on the clinical decision<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality | Defined by Swedish registers | 5 years | 
| Reintervention | Defined by medical records | 5 years | 
| Recurrent disease | Defined by medical records | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lengths of hospital stay | defined by medical records | 5 years | 
| Number of interventions | defined by medical records | 5 years | 
| complications | defined by medical records and Swedish Registers | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency surgery, Acute surgery, Complications, Risk factors, Frailty, Ageing