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Operative Decision Discordance in Geriatric Emergency General Surgery.

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This summary is machine-generated.

Mismatched surgical care for older adults undergoing emergency general surgery (EGS) is linked to worse outcomes. This discordant care increases mortality, complications, costs, and length of stay for elderly patients.

Keywords:
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Area of Science:

  • Geriatric Surgery
  • Health Services Research
  • Surgical Outcomes

Background:

  • Nearly one million older adults are hospitalized annually for emergency general surgery (EGS) in the US.
  • Discordant care, a mismatch between treatment and patient risk, negatively impacts EGS outcomes.
  • Understanding preoperative decision variation is crucial for improving elderly EGS patient care.

Purpose of the Study:

  • To characterize the association between preoperative decision variation and outcomes in elderly EGS patients.
  • To identify the impact of model-discordance on mortality, complications, and healthcare costs.

Main Methods:

  • Analysis of geriatric (≥65 years) EGS hospitalizations from the 2022 National Inpatient Sample (NIS).
  • Development of a propensity score (PS) to predict operative management likelihood.
  • Classification of patients into model-concordant and model-discordant groups based on PS cutoff (0.5).
  • Multivariable regression models to assess the association of care variation with outcomes.

Main Results:

  • 17.1% of elderly EGS patients (154,300 out of 900,730) were classified as model-discordant.
  • Model-discordance significantly increased odds of mortality (AOR: 1.33) and complications (GI, infectious, respiratory).
  • Discordant care was associated with increased hospitalization costs (+$9,760) and longer length of stay (+2.72 days).

Conclusions:

  • Model-discordant patients experienced higher in-hospital mortality and postoperative complication rates.
  • Significant variation in preoperative decision-making exists in elderly EGS patients.
  • Further investigation into guideline adherence and outcomes in this vulnerable population is warranted.