Cheryl K. Zogg

National estimates of predictors of outcomes for emergency general surgery.

BACKGROUND Identifying predictors of mortality and surgical complications has led to outcome improvements for a variety of surgical conditions. However, similar work has yet to be done for factors affecting outcomes of emergency general surgery (EGS). The objective of this study was to determine the predictors of in-hospital complications and mortality among EGS patients. METHODS The Nationwide Inpatient Sample (2003–2011) was queried for patients with conditions encompassing EGS as determined by the American Association for Surgery of Trauma, categorizing them into predefined EGS groups using DRG International Classification of Diseases—9th Rev.—Clinical Modification codes. Primary outcomes considered included incidence of a major complication (pneumonia, pulmonary emboli, urinary tract infections, myocardial infarctions, sepsis, or septic shock) and in-hospital mortality. Separate multivariate logistic regression analyses for complications and mortality were performed to identify risk factors of either outcome from the following domains: patient demographics (age, sex, insurance type, race, and income quartile), comorbidities, and hospital characteristics (location, teaching status, and bed size). RESULTS This study included 6,712,151 discharge records, weighted to represent 32,910,446 visits for EGS conditions. Mean age was 58.50 (19.74) years; slightly more than half (54.66%) were female. Uninsured patients were more likely to die (odds ratio,1.25; 95% confidence interval, 1.20–1.30), whereas patients in the highest income quartile had the least likelihood of mortality (odds ratio, 0.86; 95% confidence interval, 0.84–0.87). Old age was an independent predictor of mortality for all EGS subdiagnoses. The overall mortality rate was 1.76%; the overall complication rate was 10.03%. Of the patients who died, 62% experienced at least one major complication. Patients requiring resuscitation had the highest likelihood of mortality followed by patients with vascular disease and hepatic disease. CONCLUSION Death patterns of EGS patients were discerned using an administrative data set. Understanding patterns of mortality and complications derived from studies such as this could improve hospital benchmarking for EGS, akin to trauma surgery’s previous success. LEVEL OF EVIDENCE Prognostic and epidemiologic study, level III.

Incremental Cost of Emergency Versus Elective Surgery.

OBJECTIVE To determine hospital costs and the adjusted risk of death associated with emergent versus elective surgery. BACKGROUND Emergency surgery has a higher cost and worse outcomes compared with elective surgery. However, no national estimates of the excess burden of emergency surgery exist. METHODS Nationwide Inpatient Sample (NIS) data from 2001 to 2010 were analyzed. Patients aged 18 years or older who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, or colon resection for neoplasm were included. Using generalized linear models with propensity scores, cost differences for emergent versus elective admission were calculated for each procedure. Multivariable logistic regression was performed to investigate the adjusted odds of mortality comparing elective and emergent cases. Discharge-level weights were applied to analyses. RESULTS A total of 621,925 patients, representing a weighted population of 3,057,443, were included. The adjusted mean cost difference for emergent versus elective care was

Influence of body mass index on outcomes after major resection for cancer

8741.22 (30% increase) for abdominal aortic aneurysm repair,

Analgesic Access for Acute Abdominal Pain in the Emergency Department Among Racial/Ethnic Minority Patients: A Nationwide Examination.

5309.78 (17% increase) for coronary artery bypass graft, and

Impact of ACA Insurance Coverage Expansion on Perforated Appendix Rates Among Young Adults.

7813.53 (53% increase) for colon resection. If 10% of the weighted estimates of emergency procedures had been performed electively, the cost benefit would have been nearly

Inpatient Pediatric Tonsillectomy Does Hospital Type Affect Cost and Outcomes of Care

1 billion, at

Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study.

996,169,160 (95% confidence interval [CI],

From understanding to action: interventions for surgical disparities.

985,505,565-

Implications of the patient protection and affordable care act on insurance coverage and rehabilitation use among young adult trauma patients

1,006,834,104). Elective surgery patients had significantly lower adjusted odds of mortality for all procedures. CONCLUSIONS Even a modest reduction in the proportion of emergent procedures for 3 conditions is estimated to save nearly

Operative delay to laparoscopic cholecystectomy: Racking up the cost of health care

1 billion over 10 years. Preventing emergency surgery through improved care coordination and screening offers a tremendous opportunity to save lives and decrease costs.