Multicenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program

Shafi, Shahid; Priest, Elisa L.; Crandall, Marie; Klekar, Christopher S.; Ali, Nazim; Aboutanos, Michel B.; Agarwal, Suresh; Bhattacharya, Bishwajit; Byrge, Nickolas; Dhillon, Tejveer S.; Eboli, Dominick J.; Fielder, Drew; Guillamondegui, Oscar D.; Gunter, Oliver L.; Inaba, Kenji; Mowery, Nathan T.; Nirula, Raminder; Ross, Steven E.; Savage, Stephanie A.; Schuster, Kevin M.; Schmoker, Ryan K.; Siboni, Stefano; Siparsky, Nicole; Trust, Marc D.; Utter, Garth H.; Whelan, James; Feliciano, David V.; Rozycki, Grace S.

doi:10.1097/ta.0000000000000943

Cited by 52 publications

(21 citation statements)

References 11 publications

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“…These detailed categories of anatomic severity were created based on clinical, imaging, endoscopic, operative, and pathologic criteria (8). The AAST suggests that these scoring systems must be validated and their applicability defined for each of the EGS pathologies (8,10,11). Due to the criteria being strongly based on intra-operative findings, these systems cannot be used to determine the need for operative management.…”

Section: Introductionmentioning

confidence: 99%

Increased anatomic severity predicts outcomes

Hernandez

Aho

Habermann

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Determination and reporting of disease severity in emergency general surgery (EGS) lacks standardization. Recently, the American Association for the Surgery of Trauma (AAST) proposed an anatomic severity grading system. We aimed to validate this system in patients with appendicitis, and determine if cross sectional imaging correlates with disease severity at operation. Methods Patients 18 years or older undergoing treatment for acute appendicitis between 2013 and 2015 were identified. Baseline demographics, procedure types were recorded, and AAST grades were assigned based on intraoperative and radiologic findings. Outcomes including length of stay, 30 day mortality, and complications based on Clavien-Dindo categories and National Surgical Quality Improvement Program variables. Summary statistical univariate, nominal logistic and standard least squares analyses were performed comparing AAST grade with key outcomes. Bland-Altman analysis compared operative findings to preoperative cross sectional imaging to compare assigning grades. Results 334 patients with mean (±SD) age of 39.3 years (±16.5) were included (53% male) and all patients had cross sectional imaging. 299 underwent appendectomy, and 85% completed laparoscopic. 30 day mortality rate was 0.9%, complication rate 21%. Increased median [IQR] AAST grade was recorded in patients with complications 2 [1-4] compared to those without 1 [1-1], p=0.001. For operative management, a median [IQR] AAST grades were significantly associated with procedure type: laparoscopic 1 [1-1], open 4 [2-5] conversion to open 3 [1-4], p=0.001. Increased median [IQR] AAST grades were significantly associated in non-operative management: patients having a complication had a higher median AAST grade of 4 [3-5], compared to those without 3 [2-3], p=0.001. Bland Altman analysis comparing AAST grade and cross sectional imaging demonstrated no difference; −0.02 ±0.02 p = 0.2 coefficient of repeatability 0.9. Conclusions The AAST grading system is valid in our population. Increased AAST grade is associated with open procedures, complications, and length of stay. AAST EGS grade determined by preoperative imaging strongly correlated to operative findings.

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Section: Introductionmentioning

confidence: 99%

Increased anatomic severity predicts outcomes

Hernandez

Aho

Habermann

et al. 2017

Journal of Trauma and Acute Care Surgery

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“…The diverticulitis scale was recently examined in a multicenter trial. 11 The system showed good inter-rater reliability as well as a clear association of increasing score with worse outcome and higher resource consumption. Similar work looking at the AAST grading scale for appendicitis has shown strong correlation between AAST severity grade assigned by preoperative cross-sectional imaging and intraoperative findings.…”

Section: Severity Stratificationmentioning

confidence: 87%

Defining burden and severity of disease for emergency general surgery

Miller

2017

Trauma Surg Acute Care Open

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As general surgery trainees continue to enter specialty practice at a high rate, fewer and fewer are caring for emergency general surgery (EGS) patients. Thus EGS has become one of the cornerstones of the practice of acute care surgery. With the centralization of this area of surgical care in many areas of the country, a clear understanding of the issues associated with this becomes vital. Understanding the public health implications with respect to burden of care and cost will allow for appropriate planning and resource allocation in the future. In addition, the development of validated severity modeling will help with risk stratification in future study of these diseases.

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“…However, this program is not well suited for EGS owing to several factors, including nonoperative management of many EGS diagnoses and the relatively small proportion of EGS cases in the database, which con tributes to concerns related to National Surgical Quality Improvement Program sampling methodology. 37 Multiple studies have evaluated the impact of EGS on the efficiency of hospital care and patient outcomes. However, the substantial variability in specific outcome variables and their definitions makes it impossible to generalize or com pare these results between centres.…”

Section: Discussionmentioning

confidence: 99%

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

Vergis¹,

Metcalfe²,

Stogryn³

et al. 2019

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Background: Dedicated emergency general surgery (EGS) service models were developed to improve efficiency of care and patient outcomes. The degree to which the EGS model delivers these benefits is debated. We performed a systematic review of the literature to identify whether the EGS service model is associated with greater efficiency and improved outcomes compared to the traditional model. Methods:We searched MEDLINE, Embase, Scopus and Web of Science (Core Collection) databases from their earliest date of coverage through March 2017. Pri mary outcomes for efficiency of care were surgical response time, time to operation and total length of stay in hospital. The primary outcome for evaluating patient out comes was total complication rate. Results:The EGS service model generally improved efficiency of care and patient outcomes, but the outcome variables reported in the literature varied.Conclusion: Development of standardized metrics and comprehensive EGS data bases would support quality control and performance improvement in EGS systems.

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Multicenter validation of American Association for the Surgery of Trauma grading system for acute colonic diverticulitis and its use for emergency general surgery quality improvement program

Abstract: Prognostic study, level V.

Cited by 52 publications

References 11 publications

Increased anatomic severity predicts outcomes

Increased anatomic severity predicts outcomes

Defining burden and severity of disease for emergency general surgery

Impact of acute care surgery on timeliness of care and patient outcomes: a systematic review of the literature

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