General surgeon involvement in the care of patients designated with an American Association for the Surgery of Trauma–endorsed ICD-10-CM emergency general surgery diagnosis code in Wisconsin

Abstract

BACKGROUND:The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions. METHODS:We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician. RESULTS:Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes. CONCLUSION:Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients.

Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

“…This process yielded an inclusive list of codes similar to that which has recently been endorsed by the American Association for the Surgery of Trauma. 14 The goal of this study was to reflect the initial management decision to the best of our ability. Patients undergoing nonoperative management as Plan A may certainly have crossed over and undergone surgery if their condition changed.…”

“…12,13 Medicare patients account for 1/3 to 1/2 of EGS patients. 7,11,14 General surgery operations were identified using standard Current Procedural Terminology (CPT) codes. 15 Patients who did not have continuous Part A & B coverage or who were enrolled in an HMO at any time between 6 months before and 6 months after their index EGS admission were excluded to ensure that available claims represented all billable encounters.…”

The physiology of failure: Identifying risk factors for mortality in emergency general surgery patients using a regional health system integrated electronic medical record

“…This could have impacted the results depending on the patient's level of health during each admission. In addition, we were unable to limit our population to requiring management by surgeons or surgical consultation because of the data set inherent limitations; however, studies demonstrate that often management of EGS patients does not include surgical input 48 . The emergent presentation of EGS diseases also introduces inherent challenges because of insufficient time to workup coexisting diagnoses and presence of undiagnosed comorbidities.…”

“…In addition, we were unable to limit our population to requiring management by surgeons or surgical consultation because of the data set inherent limitations; however, studies demonstrate that often management of EGS patients does not include surgical input. 48 The emergent presentation of EGS diseases also introduces inherent challenges because of insufficient time to workup coexisting diagnoses and presence of undiagnosed comorbidities. Patients additionally were identified if they had one or more of the AAST-defined EGS ICD codes in their diagnosis list, and the EGS diagnosis may not have been the primary reason for admission.…”

Greater Patient Sharing between Hospitals is Associated with Better Outcomes for Transferred Emergency General Surgery Patients

“…Emergency general surgery patients 18 years and older were identified using the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes consensus definitions 30 with a qualifying International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code as a primary diagnosis during an ED or acute care hospital encounter in a nonfederal institution and were included 30 . All patients in the cohort resided in WI at the time of their qualifying encounter.…”