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Why Potentially Elective General Surgery Becomes Emergent: A Multi-Methods Approach.

Denise M Garofalo1, Quintin W O Myers2, Charlotte H Heron1

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Many patients needing elective surgery end up in emergency general surgery (EGS) due to delayed care. Social determinants of health (SDoH) and access barriers prevent timely elective procedures, increasing risks for patients.

Keywords:
Emergency general surgeryHealthcare accessHealthcare disparitiesSocial determinants of healthSurgical equity

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Area of Science:

  • General Surgery
  • Health Services Research
  • Public Health

Background:

  • Emergency general surgery (EGS) is associated with higher morbidity and mortality than elective surgery.
  • Social determinants of health (SDoH) significantly impede healthcare access, contributing to increased EGS utilization.
  • Many emergent conditions could be managed electively with earlier intervention.

Purpose of the Study:

  • To investigate the reasons why patients with potentially elective surgical conditions undergo EGS.
  • To identify barriers preventing patients from receiving timely elective surgical care.

Main Methods:

  • Retrospective review of 995 adult patients undergoing EGS with elective alternatives at an academic center (2018-2019).
  • Analysis of patient demographics, clinical course, and circumstances surrounding surgical timing.
  • Multi-methods approach to determine failures in elective management, including statistical comparisons.

Main Results:

  • Only 10.5% of identified patients (104/995) were evaluated by primary care, with fewer referred to or evaluated by general surgery.
  • Key reasons for failure to receive elective surgery included comorbidity optimization (42%), scheduling difficulties (28%), SDoH (22%), missed diagnosis (14%), and patient preference (11%).
  • SDoH barriers included financial, childcare, transportation, and employment issues.

Conclusions:

  • A significant majority of patients admitted for EGS at this institution had not seen a physician prior to admission.
  • Even with primary care access, the likelihood of being scheduled for elective surgery remains low (approximately 20%).
  • Improving access to preventive care and streamlining the pathway from diagnosis to elective surgery are crucial for reducing EGS utilization.