"AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE"-RETROSPECTIVE ANALYSIS OF EMERGENCY SURGERIES PERFORMED IN A TERTIARY CARE TEACHING HOSPITAL.

Dr. James Chacko, MBBS, DNB, DA, DCH, *Dr. Asish Karthik, MD, FCA, FIPM, Dr. Dhanesh S., MBBS, MD, Dr. Sruthy Unni, MBBS, Dr. Randeep A. M., MBBS and Aparna Satish, MBBS

ABSTRACT

Background: surgeries performed in emergency operating room are challenging, demands significant work force and quick mobilization of resources, causing significant brunt on health care system. Can we reduce this patient load and damages? We performed a retrospective analysis of a year’s data in search of an answer. Methods: A retrospective chart review of 2026 patients who underwent emergency surgery in a tertiary care teaching hospital with a round the clock functioning EMD and operating room. We analyzed demographic data, type of anaesthesia, American Society of Anaesthesiologists physical status(ASA PS), intraoperative inotropic support,ICU admission and finally the patient outcome. Results: Only 70 (2.5%) of ASA PS I patients needed ICU admission. The incidence of ICU admission in ASA PS II category were 43 (6.1%) and ASA PS III category were 63 (21.6%). 260 (73.4%) of ASA PS IV needed ICU admission. 363 (42.9%) patients following general anaesthetic technique were admitted in the ICU postoperatively where as only 20(1.7%) patients needed ICU admission following regional anaesthesia. 69 (3.4%) patients among 2026 needed inotropic support during the study period of which 66 (95.7%) needed ICU admission postoperatively. Conclusion: This data confirm the association between increasing ASA PS designation and need for postoperative intensive care. General anesthetic techniques and intraoperative inotropes also led to more incidences of postoperative ICU admissions and poor outcome emphasizing the significance of preventive strategies and early resuscitation.

Keywords: ASA PS, Anaesthesia, Emergency surgery, outcome.