Acute Care Surgery Model and Outcomes in Emergency General Surgery.

Emergencies General Surgery / organization & administration Hospital Mortality Humans Michigan Models, Organizational Outcome Assessment, Health Care Practice Patterns, Physicians' / statistics & numerical data Surgeons / statistics & numerical data

Journal

Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305

Informations de publication

Date de publication:
01 2019
Historique:
received: 01 07 2018
accepted: 17 07 2018
pubmed: 26 10 2018
medline: 16 11 2019
entrez: 26 10 2018
Statut: ppublish

Résumé

Annually, more than 2 million patients are admitted with emergency general surgery (EGS) conditions. Emergency general surgery cases comprise 11% of all general surgery operations, yet account for 47% of mortalities and 28% of complications. Using the statewide general surgery Michigan Surgical Quality Collaborative (MSQC) data, we previously confirmed that wide variations in EGS outcomes were unrelated to case volume/complexity. We assessed whether patient care model (PCM) affected EGS outcomes. There were 34 hospitals that provided data for PCM, resources, surgeon practice patterns, and comprehensive MSQC patient data from January 1, 2008 to December 31, 2016 (general surgery cases = 126,494; EGS cases = 39,023). Risk and reliability adjusted outcomes were determined using hierarchical multivariable logistic regression analysis with multiple clinical covariates and PCM. The general surgery service (GSS) model was more common (73%) than acute care surgery (ACS, 27%). Emergency general surgery 30-day mortality was 4.1% (intestinal resections 11.6%). The ACS model was associated with a reduction of 31% in mortality (odds ratio [OR] 0.69; 95% CI 0.52-0.92] for EGS cases, related to decreased mortality in the intestinal resection cohort (8.5% ACS vs 12% GSS, p < 0.0001). Morbidity in EGS was 17.4% (9.7% elective); highest (40%) in intestinal resection, and PCM did not affect morbidity. We identified specific variables for an optimal EGS risk adjustment model. This is the first multi-institutional study to identify that an ACS model is associated with a significant 31% mortality reduction in EGS using prospectively collected, clinically obtained, research-quality collaborative data. We identified that new risk adjustment models are necessary for EGS outcomes evaluations.

Sections du résumé

BACKGROUND
Annually, more than 2 million patients are admitted with emergency general surgery (EGS) conditions. Emergency general surgery cases comprise 11% of all general surgery operations, yet account for 47% of mortalities and 28% of complications. Using the statewide general surgery Michigan Surgical Quality Collaborative (MSQC) data, we previously confirmed that wide variations in EGS outcomes were unrelated to case volume/complexity. We assessed whether patient care model (PCM) affected EGS outcomes.
STUDY DESIGN
There were 34 hospitals that provided data for PCM, resources, surgeon practice patterns, and comprehensive MSQC patient data from January 1, 2008 to December 31, 2016 (general surgery cases = 126,494; EGS cases = 39,023). Risk and reliability adjusted outcomes were determined using hierarchical multivariable logistic regression analysis with multiple clinical covariates and PCM.
RESULTS
The general surgery service (GSS) model was more common (73%) than acute care surgery (ACS, 27%). Emergency general surgery 30-day mortality was 4.1% (intestinal resections 11.6%). The ACS model was associated with a reduction of 31% in mortality (odds ratio [OR] 0.69; 95% CI 0.52-0.92] for EGS cases, related to decreased mortality in the intestinal resection cohort (8.5% ACS vs 12% GSS, p < 0.0001). Morbidity in EGS was 17.4% (9.7% elective); highest (40%) in intestinal resection, and PCM did not affect morbidity. We identified specific variables for an optimal EGS risk adjustment model.
CONCLUSIONS
This is the first multi-institutional study to identify that an ACS model is associated with a significant 31% mortality reduction in EGS using prospectively collected, clinically obtained, research-quality collaborative data. We identified that new risk adjustment models are necessary for EGS outcomes evaluations.

Identifiants

DOI: 10.1016/j.jamcollsurg.2018.07.664 PMID: 30359826
pubmed: 30359826
pii: S1072-7515(18)32025-8
doi: 10.1016/j.jamcollsurg.2018.07.664
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

21-28.e7

Investigateurs

Wallace Arneson (W)
Mandip Atwal (M)
Scott A Barnes (SA)
David Bartholomew (D)
Richard Bates (R)
Kent C Bowden (KC)
Anthony Bozaan (A)
Peter Bistolarides (P)
Christopher Bruck (C)
Karen Buhariwalla (K)
Jill Cherry-Bukowiec (J)
Laurence Cheung (L)
Heather Dolman (H)
David Edelman (D)
Michael Englesbe (M)
Harold L Gallick (HL)
Andrea Goethals (A)
Andrew Gordon (A)
Krista Gustad (K)
Chadi G Haddad (CG)
Jeffrey L Johnson (JL)
Alicia Kieninger (A)
Ramachandra Kolachalam (R)
David S Kwon (DS)
Martin Luchtefeld (M)
David Machado-Aranda (D)
Kevin Markham (K)
Michael McLeod (M)
Ahmed Meguid (A)
Raouf A Mikhail (RA)
Dawn E Morey (DE)
Walter C Noble (WC)
Shawn Obi (S)
Sujal Patel (S)
Carl Matthew Pesta (CM)
Mark W Puls (MW)
Todd Richardson (T)
Christopher N Scipione (CN)
Melwyn Sequeira (M)
Brian Shapiro (B)
Amy Spencer (A)
Kimiko D Sugimoto (KD)
Attila Ulgenalp (A)
Stephen VanWylen (S)
Thomas J Veverka (TJ)
James Wagner (J)
Kenneth Wilson (K)
Douglas Zwemer (D)
Karen Alberts (K)
Teresa Bailey (T)
Jennifer Barnes (J)
Heather Behring (H)
Cynthia Christiansen (C)
Maryellen Cusick (M)
Nancy Demeter (N)
Angela Dunn (A)
Elizabeth Gates (E)
Michele Guild (M)
Julie Hayes (J)
Deb Hischke (D)
Denise Jobson (D)
Jori Kennedy (J)
Jakcie Machnacki (J)
Barb Moe (B)
Shawanda Myers (S)
Beverly Parker (B)
Tina Costello-Percha (T)
Jona Piazza (J)
Wendy Pioch (W)
Amy Poindexter (A)
Jennifer Reed (J)
Betty Riegel (B)
Dawn Robertson (D)
John Robertson (J)
Kris Ryan (K)
Connie Shaw (C)
Alisa Sherrard Jacob (AS)
Kim Sweeny (K)
William Tadian (W)
Lori Thomas (L)
Deborah Thompson (D)
Mary Young (M)
Michael Englesbe (M)
Committee Chair (C)
Darrell A Campbell (DA)
Greta Krapohl (G)
Elizabeth Seese (E)
Kathy Bishop (K)
Frederick Armenti (F)
Chad Brummett (C)
John Byrn (J)
Dragos Galusca (D)
Samantha Hendren (S)
Beckie Hoppe (B)
Robert Cleary (R)
Mary Hawk (M)
Julie Hayes (J)
Larry Lloyd (L)
Martin Luchtefeld (M)
Ashraf Mansour (A)
Fady Moustarah (F)
Larry McCahill (L)
Michael McLeod (M)
Dan Morgan (D)
Walter Noble (W)
Tina Percha (T)
Lyndia Poe (L)
James Ogilvie (J)
Kimiko Sugimoto (K)
Deborah Thompson (D)
Marianne Wynkoop (M)

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Auteurs

Kathleen B To (KB)

Department of Surgery, University of Michigan, Ann Arbor, MI. Electronic address: Kathleen.To@umm.edu.

Neil S Kamdar (NS)

Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.

Preethi Patil (P)

Department of Surgery, University of Michigan, Ann Arbor, MI.

Stacey D Collins (SD)

Michigan Surgical Quality Collaborative, Ann Arbor, MI.

Elizabeth Seese (E)

Michigan Surgical Quality Collaborative, Ann Arbor, MI.

Greta L Krapohl (GL)

Michigan Surgical Quality Collaborative, Ann Arbor, MI.

Darrell Skip Campbell (DS)

Michigan Surgical Quality Collaborative, Ann Arbor, MI.

Michael J Englesbe (MJ)

Department of Surgery, University of Michigan, Ann Arbor, MI; Michigan Surgical Quality Collaborative, Ann Arbor, MI.

Mark R Hemmila (MR)

Department of Surgery, University of Michigan, Ann Arbor, MI.

Lena M Napolitano (LM)

Department of Surgery, University of Michigan, Ann Arbor, MI.

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Classifications MeSH

questionsmedicales.fr › Environnement et santé publique › Santé publique › Urgences › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Professions de santé › Médecine › Spécialités chirurgicales › Chirurgie générale › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › Acute Care Surgery Model and Outcomes in...
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questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › États du Centre-Ouest des États-Unis › Michigan › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Modèles d'organisation › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Types de pratiques des médecins › Acute Care Surgery Model and Outcomes in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Chirurgiens › Acute Care Surgery Model and Outcomes in...