Emergency general surgery was associated with a higher risk of 30-day overall morbidity compared to elective surgery (OR 1.20; 95% CI 1.16-1.23), with inconsistent hospital performance across both.
Observational (n=473,619)
Yes
Do patient outcomes and hospital performance differ between emergency general surgery and elective general surgery?
Emergency general surgery carries a substantially higher risk of adverse events than elective surgery, and hospital performance in elective surgery does not reliably predict performance in emergency surgery.
Odds Ratio: 1.2 (95% CI 1.16–1.23)
BACKGROUND: Surgical quality improvement has focused on elective general surgery (ELGS) outcomes despite the substantial risk associated with emergency general surgery (EMGS) procedures. Furthermore, any differences in the quality of care provided to EMGS versus ELGS patients are not well described. We compared risk factors and risk-adjusted outcomes associated with EMGS and ELGS procedures to assess whether hospitals have comparable outcomes across these procedures. STUDY DESIGN: Using American College of Surgeons National Surgical Quality Improvement Program data (2005 to 2008), regression models were constructed for 30-day overall morbidity, serious morbidity, and mortality among all patients, EMGS patients, and ELGS patients. Observed-to-expected (O/E) ratios were calculated from models based on EMGS or ELGS patients. Association of hospital performance after EMGS versus ELGS procedures was assessed by evaluating correlations of O/E ratios; agreement in outlier status (hospitals where O/E confidence intervals CI do not overlap 1.0) was evaluated with weighted kappa. RESULTS: Of 473,619 procedures, 67,445 (14.2%) patients underwent an EMGS procedure. EMGS patients were more likely to experience any morbidity (odds ratio OR 1.20; 95% CI 1.16 to 1.23), serious morbidity (OR 1.26; 95% CI 1.21 to 1.30), and mortality (OR 1.39; 95% CI 1.30 to 1.48). Correlation between O/E ratios for EMGS and ELGS were moderate to low (overall morbidity = 0.48, p < 0.0001; serious morbidity = 0.41, p < 0.0001, mortality = 0.18, p = 0.01). Outlier status was not consistent across EMGS and ELGS, with only slight agreement (overall morbidity = 0.18, p < 0.0001; serious morbidity = 0.16, p = 0.001, mortality = 0.19, p = 0.01). CONCLUSIONS: EMGS patients are at substantially greater risk than ELGS patients for adverse events. Hospitals do not appear to have highly consistent performance across EMGS and ELGS outcomes. Processes of care that afford improved outcomes to EMGS patients need to be identified and disseminated.
Ingraham et al. (Fri,) conducted a observational in General surgery (n=473,619). Emergency general surgery (EMGS) vs. Elective general surgery (ELGS) was evaluated on 30-day overall morbidity (OR 1.20, 95% CI 1.16 to 1.23). Emergency general surgery was associated with a higher risk of 30-day overall morbidity compared to elective surgery (OR 1.20; 95% CI 1.16-1.23), with inconsistent hospital performance across both.