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Differences Between Center-level Outcomes in Emergency and Elective General Surgery.

Justin S Hatchimonji1, Lucy W Ma2, Elinore J Kaufman3

  • 1Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

The Journal of Surgical Research
|January 2, 2021
PubMed
Summary

Surgical quality metrics for elective surgery (ELS) do not predict emergency general surgery (EGS) performance. Centers rarely performed similarly in both ELS and EGS, highlighting opportunities for EGS-specific quality improvement.

Keywords:
Emergency surgeryFailure-to-rescuePerformance metricsQuality improvement

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Area of Science:

  • Healthcare quality assessment
  • Surgical outcomes research
  • Health services research

Background:

  • Center-level outcome metrics are established for elective surgery (ELS) but not specifically for emergency general surgery (EGS).
  • Current comparisons often use ELS or combined data, obscuring EGS-specific quality of care.
  • Evaluating EGS quality independently is crucial for targeted improvements.

Purpose of the Study:

  • To assess the correlation between center-level performance in elective surgery (ELS) and emergency general surgery (EGS).
  • To determine if centers excelling in ELS also excel in EGS.
  • To identify potential disparities in quality metrics between ELS and EGS.

Main Methods:

  • Extracted 2016 State Inpatient Database data for EGS and ELS patients from FL, NY, and KY.
  • Included centers performing >100 ELS and EGS operations.
  • Calculated risk-adjusted mortality, complication, and failure to rescue (FTR) rates; compared observed-to-expected ratios and performance categories between EGS and ELS.

Main Results:

  • Analyzed 204 centers, 45,500 EGS cases, and 49,380 ELS cases.
  • Found no significant correlation between EGS and ELS mortality performance (36 centers differed categories).
  • Low correlation for complication rates (0.20, 60 centers differed) and no correlation for FTR rates (16 centers differed).

Conclusions:

  • Minimal correlation exists between elective surgery (ELS) and emergency general surgery (EGS) outcomes.
  • High performance in one surgical category does not translate to the other.
  • Differences in care processes likely impact ELS and EGS outcomes, indicating a need for EGS-specific quality improvement strategies.