Abstract：
BACKGROUND: Emergency presentations make up a large proportion of a general surgeon\'s workload. Patients who have emergency surgery carry a higher rate of mortality and complications. We aim to review the impact of surgical subspecialization on patients following upper gastrointestinal (UGI) emergency surgery.
METHODS: A systematic search of Ovid Embase, Ovid MEDLINE, and Cochrane databases using a predefined search strategy was completed reviewing studies published from 1st of January 1990 to August 27, 2023. The study was prospectively registered with PROSPERO (CRD42022359326). Studies were reviewed for the following outcomes: 30-day mortality, in-hospital mortality, conversion to open, length of stay, return to theater, and readmission.
RESULTS: Of 5181 studies, 24 articles were selected for full text review. Of these, seven were eligible and included in this study. There was a statistically significant improvement in 30-day mortality favoring UGI specialists (OR 0.71 [95% CI 0.55-0.92 and p = 0.009]) and in-hospital mortality (OR 0.29 [95% CI 0.14-0.60 and p = 0009]). There was a high degree of study heterogeneity in 30-day mortality; however, a low degree of heterogeneity within in-hospital mortality. There was no statistical significance when considering conversion to open and insufficient data to allow meta-analysis for return to theater or readmission rates.
CONCLUSIONS: In emergency UGI surgery, there was improved 30-day and in-hospital mortality for UGI specialists. Therefore, surgeons should consider early involvement of a subspecialist team to improve patient outcomes.
METHODS: A systematic search of Ovid Embase, Ovid MEDLINE, and Cochrane databases using a predefined search strategy was completed reviewing studies published from 1st of January 1990 to August 27, 2023. The study was prospectively registered with PROSPERO (CRD42022359326). Studies were reviewed for the following outcomes: 30-day mortality, in-hospital mortality, conversion to open, length of stay, return to theater, and readmission.
RESULTS: Of 5181 studies, 24 articles were selected for full text review. Of these, seven were eligible and included in this study. There was a statistically significant improvement in 30-day mortality favoring UGI specialists (OR 0.71 [95% CI 0.55-0.92 and p = 0.009]) and in-hospital mortality (OR 0.29 [95% CI 0.14-0.60 and p = 0009]). There was a high degree of study heterogeneity in 30-day mortality; however, a low degree of heterogeneity within in-hospital mortality. There was no statistical significance when considering conversion to open and insufficient data to allow meta-analysis for return to theater or readmission rates.
CONCLUSIONS: In emergency UGI surgery, there was improved 30-day and in-hospital mortality for UGI specialists. Therefore, surgeons should consider early involvement of a subspecialist team to improve patient outcomes.
摘要：
背景：急诊报告占普通外科医生工作量的很大一部分。接受急诊手术的患者死亡率和并发症发生率较高。我们旨在回顾手术亚专业化对上消化道（UGI）急诊手术后患者的影响。
方法：对OvidEmbase的系统搜索，OvidMEDLINE,使用预定义搜索策略的Cochrane数据库完成了对1990年1月1日至2023年8月27日发表的研究的回顾。该研究在PROSPERO（CRD42022359326）进行了前瞻性注册。对以下结果的研究进行了回顾：30天死亡率，住院死亡率，转换为开放，逗留时间,回到剧院,和重新接纳。
结果：在5181项研究中，选取24篇文章进行全文综述。其中,7人符合研究条件并纳入本研究.对UGI专家有利的30天死亡率（OR0.71[95％CI0.55-0.92，p=0.009]）和住院死亡率（OR0.29[95％CI0.14-0.60，p=0009]）有统计学上的显着改善。30天死亡率的研究异质性很高；然而，住院死亡率的异质性程度较低。考虑转换为开放数据和不足数据以进行返回剧院或再入院率的荟萃分析时，没有统计学意义。
结论：在急诊UGI手术中，UGI专科医生的30日死亡率和院内死亡率均有所改善.因此,外科医生应考虑亚专科团队的早期参与，以改善患者的预后。
方法：对OvidEmbase的系统搜索，OvidMEDLINE,使用预定义搜索策略的Cochrane数据库完成了对1990年1月1日至2023年8月27日发表的研究的回顾。该研究在PROSPERO（CRD42022359326）进行了前瞻性注册。对以下结果的研究进行了回顾：30天死亡率，住院死亡率，转换为开放，逗留时间,回到剧院,和重新接纳。
结果：在5181项研究中，选取24篇文章进行全文综述。其中,7人符合研究条件并纳入本研究.对UGI专家有利的30天死亡率（OR0.71[95％CI0.55-0.92，p=0.009]）和住院死亡率（OR0.29[95％CI0.14-0.60，p=0009]）有统计学上的显着改善。30天死亡率的研究异质性很高；然而，住院死亡率的异质性程度较低。考虑转换为开放数据和不足数据以进行返回剧院或再入院率的荟萃分析时，没有统计学意义。
结论：在急诊UGI手术中，UGI专科医生的30日死亡率和院内死亡率均有所改善.因此,外科医生应考虑亚专科团队的早期参与，以改善患者的预后。
