Quick Cuts: Surgeon Tendency to Operate in Emergency General Surgery

Area of Science:

• Surgical Practice Patterns
• Health Services Research
• Patient Outcomes

Background:

• Individual surgeon practice patterns exhibit variability.
• The extent of variation in operative versus nonoperative treatment for emergency general surgery (EGS) conditions is not well understood.
• This study investigates surgeon-level differences in operative treatment utilization for EGS.

Purpose of the Study:

• To examine the variation in operative treatment rates among individual surgeons for emergency general surgery (EGS) conditions.
• To compare the practice patterns of surgeons with low versus high operative treatment rates.
• To assess the impact of surgeon variability on patient management in EGS.

Main Methods:

• Utilized the Healthcare Cost and Utilization Project State Inpatient Database (2016-2020) in FL/MD/NV.
• Identified adult patients hospitalized for EGS conditions using ICD-10 codes.
• Calculated surgeon-level 'Tendency To Operate' (TTO) and compared surgeon attributes across TTO quartiles.

Main Results:

• 1884 surgeons treated 347,589 EGS patients; median surgeon TTO was 59% for all EGS conditions.
• Median TTO varied by condition: 44% for complicated diverticulitis, 74% for cholecystitis.
• Low-TTO surgeons treated fewer EGS patients annually (median 23 vs. 41), but overall annual patient volume was similar to high-TTO surgeons.

Conclusions:

• Operative treatment for EGS conditions is influenced by the individual surgeon.
• A significant proportion of EGS conditions are managed nonoperatively by surgeons.
• Surgeons' comprehensive expertise, encompassing both operative and nonoperative management, warrants appropriate compensation.