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Related Experiment Video

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Emergency Undocking in Robotic Surgery: A Simulation Curriculum
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High Resource Utilization in Emergent Versus Elective General Surgery.

Giannina Rokvic1, Daniel L Davenport2, Charles F Campbell3

  • 1University of Kentucky, College of Medicine, Lexington, Kentucky.

The Journal of Surgical Research
|September 7, 2021
PubMed
Summary
This summary is machine-generated.

Emergent general surgery (EGS) patients utilize more hospital resources than same-day elective surgery (SDGS) patients, even after accounting for clinical factors. New payment models are needed to address this disparity in healthcare resource utilization.

Keywords:
Elective surgeryEmergent surgeryNSQIPResource utilization

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Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Healthcare Economics

Background:

  • Pay-for-performance metrics necessitate understanding factors influencing high resource utilization (HRU).
  • Distinguishing HRU drivers in emergent general surgery (EGS) versus same-day elective surgery (SDGS) is crucial for optimizing care and costs.

Purpose of the Study:

  • To identify and compare factors contributing to high resource utilization (HRU) in emergent general surgery (EGS) patients versus same-day elective surgery (SDGS) patients.
  • To inform the development of appropriate healthcare payment and performance models for different surgical pathways.

Main Methods:

  • Analysis of the 2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) public use file.
  • Inclusion of 22 general surgery procedure groups with at least 100 elective and emergent cases (83,872 total cases).
  • Definition of HRU as in-hospital stay >7 days, return to operating room, readmission, or morbidity requiring intensive care unit (ICU) stay; predictors identified via forward regression.

Main Results:

  • 33% of all patients were classified as HRU.
  • Procedures like total colectomy, enterolysis, and ileostomy showed a higher proportion of EGS cases (10.3%) compared to SDGS cases (2.6%).
  • EGS patients were significantly more likely to be HRU (OR 2.5; 95% CI 2.4-2.6), with higher rates of preoperative sepsis, severe ASA classification, low albumin, transfers, and older age.

Conclusions:

  • Emergent general surgery patients demonstrate significantly higher resource utilization than same-day elective surgery patients, beyond what is captured by the ACS-NSQIP dataset.
  • Existing payment and value-based performance models may not adequately address the complexities and resource demands of EGS.
  • Development of distinctive payment and value-based performance models tailored for EGS is essential.