Expanding the scope of quality measurement in surgery to include nonoperative care: Results from the American College of Surgeons National Surgical Quality Improvement Program emergency general surgery pilot
Key result
Although comprising only 27.4% of patients, nonoperative management accounted for 67.7% of deaths, and its inclusion caused 12 of 13 hospitals to change performance rank.
Why the study?
Does including nonoperative management in surgical quality assessment change hospital performance rankings for emergency general surgery patients?
Population
2,091 patients with emergency general surgery diagnoses sampled at 13 hospitals participating in the EGS…
Comparison
Hospital performance assessment including both… vs Hospital performance assessment including only…
Design
Cohort
Follow-up
30-day
Authors
Discussion
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Member takes
Implication
Excluding nonoperative cases may severely skew surgical quality metrics; extends the need for comprehensive mortality tracking.
Study Design
Type
Observational (n=2,091)
Multicenter
Yes
Structured PICO
Does including nonoperative management in surgical quality assessment change hospital performance rankings for emergency general surgery patients?
P
Population
2,091 patients with emergency general surgery diagnoses (appendicitis, cholecystitis, or small bowel obstruction) across 13 hospitals, followed for 30 days.
E
Exposure
Hospital performance assessment including both operative and nonoperative management.
C
Comparator
Hospital performance assessment including only operative cases.
O
Outcome
Change in hospital performance rank after including nonoperative management.
Including nonoperative management in surgical quality assessment significantly alters hospital performance rankings, highlighting a critical gap when only operative cases are evaluated.
Cite This Study
Ko et al. (2017) conducted an observational in Emergency general surgery (acute appendicitis, acute cholecystitis, small bowel obstruction) (n=2,091). Nonoperative management vs. Operative management (or exclusion of nonoperative cases) was evaluated on Change in hospital performance rank. Although comprising only 27.4% of patients, nonoperative management accounted for 67.7% of deaths, and its inclusion caused 12 of 13 hospitals to change performance rank.