Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative

Area of Science:

• Surgical Quality Improvement
• Health Systems Research
• Patient Outcomes

Background:

• Emergency general surgery (EGS) conditions are prevalent, costly, and associated with high morbidity.
• Understanding the impact of health system variations on EGS morbidity is crucial.
• A collaborative quality initiative was established to investigate EGS care and drive process improvements.

Purpose of the Study:

• To assess variations in EGS care processes and patient outcomes across multiple hospitals.
• To identify high- and low-performing hospitals in EGS care after risk adjustment.
• To evaluate the potential of collaborative quality improvement efforts in optimizing EGS outcomes.

Main Methods:

• Data collected from 10 hospitals between July 2019 and December 2022.
• Analysis of five cohorts: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and aggregate.
• Investigated operative vs. nonoperative management, mortality, morbidity, readmissions, and length of stay, with multivariable risk adjustment.

Main Results:

• 19,956 EGS patients included; adjusted aggregate mortality 3.5%, morbidity 27.6%, readmissions 15.1%.
• Significant inter-hospital variation observed in operative management (e.g., appendicitis 70.9%-96.9%), Gastrografin use (10.7%-61.4%), and cholecystostomy tube placement (23.5%-62.1%).
• Risk-adjusted outcomes revealed significant differences between hospitals, identifying outliers for mortality, morbidity, and readmissions.

Conclusions:

• A multihospital EGS collaborative identified substantial variability in care processes and outcomes.
• High morbidity rates persist in EGS across different institutions.
• Targeted quality improvement efforts are effective in identifying outliers and optimizing EGS patient outcomes.