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Regionalization of emergency general surgery operations: A simulation study.

Robert D Becher1, Nitin Sukumar, Michael P DeWane

  • 1From the Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery (R.D.B., M.P.D., A.A.M., K.M.S., K.A.D.), Yale School of Medicine; Yale Center for Analytical Sciences (N.S., M.J.S.), Yale School of Public Health; and Section of Geriatrics, Department of Internal Medicine (T.M.G.), Yale School of Medicine, New Haven, Connecticut.

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Summary

Regionalizing emergency general surgery (EGS) care to high-volume hospitals could save nearly 10% of lives. Implementing a structured EGS system could prevent 1 in 10 deaths, improving patient survival rates.

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Area of Science:

  • Surgery
  • Health Systems Research
  • Public Health

Background:

  • A tiered, regionalized system for emergency general surgery (EGS) patients, similar to trauma systems, is theorized to improve survival.
  • However, empirical data supporting the benefits of EGS regionalization are currently limited.

Purpose of the Study:

  • To quantify the potential lives saved by regionalizing EGS care to higher-volume, lower-mortality institutions.
  • To assess the impact of a structured EGS care system on patient outcomes.

Main Methods:

  • A simulation model was developed using the California Inpatient Database (2010-2011) for 10 common EGS operations.
  • Hospitals with lower EGS volumes and higher mortality rates were virtually "closed," with patients rerouted to higher-volume centers.
  • Fifty thousand bootstrap resampling simulations were performed to estimate survival benefits.

Main Results:

  • Regionalization of EGS care could prevent 9.7% of risk-adjusted deaths.
  • Significant life savings were projected across all EGS operations, ranging from 6.5% for appendectomy to 7.9% for colectomy.
  • An average of 4.6 deaths were prevented per 100 EGS patient transfers.

Conclusions:

  • Simulation indicates that a structured EGS care system could prevent approximately 1 in 10 risk-adjusted deaths.
  • These findings support the potential benefits of regionalizing EGS care.
  • Further research using more complex simulation models is recommended.