Disparities in access to emergency general surgery care in the United States

Khubchandani, Jasmine A.; Shen, Connie; Aytürk, Mehmet; Kiefe, Catarina I.; Santry, Heena P.

doi:10.1016/j.surg.2017.07.026

Cited by 119 publications

(89 citation statements)

References 72 publications

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“…Marked area-level heterogeneity in these socioeconomic variables has been reported across counties within specific US states 16,17 and contributes to county-level variations in health service utilization, including the likelihood of receiving surgical treatment. [18][19][20][21][22][23] We describe the specific association of these variables with the use of surgery for NSCLC. County-level uninsured rate is known to have strong association with demographic and area-level socioeconomic factors, 17,24 and corrective measures mitigating adverse consequences of area-level socioeconomic factors can improve access to health services and outcomes.…”

Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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BACKGROUND: Although counties are the smallest geographic level for comprehensive healthcare delivery analysis, little is known about county-level variations in receipt of curativeintent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States.METHODS: A total of 179,189 patients aged $ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with $ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression.RESULTS: Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status.CONCLUSIONS: Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors. CHEST 2020; 157(1):212-222

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Section: Discussionmentioning

confidence: 99%

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Sineshaw

Sahar

Osarogiagbon

et al. 2020

Chest

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“…Other studies are limited to selected hospitals7 21 or geographical regions23 and may not be generalisable to national populations. Our publicly funded EAS service is available to all residents independent of financial means, reducing variation in access observed in other settings 26 33. A detailed description of the structure of the health service and the database is provided to allow contextualisation and interpretation for international comparison.…”

Section: Discussionmentioning

confidence: 99%

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

et al. 2019

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ObjectivesEmergency abdominal surgery (EAS) refers to high-risk intra-abdominal surgical procedures undertaken for acute gastrointestinal pathology. The relationship between hospital or surgeon volume and mortality of patients undergoing EAS is poorly understood. This study examined this relationship at the national level.DesignThis is a national population-based study using a full administrative inpatient dataset (National Quality Assurance Improvement System) from publicly funded hospitals in Ireland.Setting24 public hospitals providing EAS services.Participants and InterventionsPatients undergoing EAS as identified by primary procedure codes during the period 2014–2018.Main outcome measuresThe main outcome measure was adjusted in-hospital mortality following EAS in publicly funded Irish hospitals. Mortality rates were adjusted for sex, age, admission source, Charlson Comorbidity Index, procedure complexity, organ system and primary diagnosis. Differences in overall, 7-day and 30-day in-hospital mortality for hospitals with low (<250), medium (250–449) and high (450+) volume and surgical teams with low (<30), medium (30–59) and high (60+) volume during the study period were also estimated.ResultsThe study included 10 344 EAS episodes. 798 in-hospital deaths occurred, giving an overall in-hospital mortality rate of 77 per 1000 episodes. There was no statistically significant difference in adjusted mortality rate between low and high volume hospitals. Low volume surgical teams had a higher adjusted mortality rate (85.4 deaths/1000 episodes) compared with high volume teams (54.7 deaths/1000 episodes), a difference that persisted among low volume surgeons practising in high volume hospitals.ConclusionPatients undergoing EAS managed by high volume surgeons have better survival outcomes. These findings contribute to the ongoing discussion regarding configuration of emergency surgery services and emphasise the need for effective clinical governance regarding observed variation in outcomes within and between institutions.

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“…Despite the universal susceptibility to EGS disease, access to EGS care is not uniformly available across the USA. With a median US county population of ~26 000, 91% of US counties with <50 000 population lack access to a hospital within the county where EGS care could be provided 21. US counties with <25th percentile population had 82% higher odds of lacking access to EGS care compared with those with >75th percentile population.…”

Section: Introductionmentioning

confidence: 99%

“…This likely explains why rural residents transferred for EGS, including common procedures such as incarcerated inguinal hernia repairs and cholecystectomies for acute cholecystitis, travel an average of 108km, with the longest distance being > 482km 22. In addition to rural areas, socioeconomically vulnerable areas, including those with higher concentration of minorities, uninsured residents, and residents lacking college degrees, are most likely to lack access to EGS care nearby 21. Therefore, regionalization is an approach to provide EGS care to these millions of Americans who would have otherwise been treated in their own communities by disappearing general surgeons.…”

Section: Introductionmentioning

confidence: 99%

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

Santry

Kao

Shafi

et al. 2019

Trauma Surg Acute Care Open

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More than three million patients every year develop emergency general surgical (EGS) conditions and this number is rising. EGS diseases range from straightforward to potentially life-threatening, and if severe or complex may require extensive resources. Given the looming surgeon shortage and concerns about access to care, regionalization of EGS care, in a manner similar to trauma care, has been proposed. We present a unique pro–con debate highlighting the salient arguments for and against regionalization of EGS care in the USA.

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Disparities in access to emergency general surgery care in the United States

Abstract: Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide.

Cited by 119 publications

References 72 publications

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States

Volume and in-hospital mortality after emergency abdominal surgery: a national population-based study

Pro-con debate on regionalization of emergency general surgery: controversy or common sense?

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