The financial burden of emergency general surgery

Ogola, Gerald; Gale, Stephen C.; Haider, Adil H.; Shafi, Shahid

doi:10.1097/ta.0000000000000787

Cited by 180 publications

(105 citation statements)

References 6 publications

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“…The use of NIS population sample data to evaluate recipients of a lung transplant is justified by the probability that lung disease is distributed within the US population in the same pattern and probability as other diseases. Hence, using these data to study end-stage lung disease should be no less valid than using them to study outcomes in heart disease, colorectal cancer, or vascular disease [28][29][30].…”

Section: Commentmentioning

confidence: 99%

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States

Hayanga

Shigemura

Aboagye³

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States

Hayanga

Shigemura

Aboagye³

et al. 2017

The Annals of Thoracic Surgery

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“…Outcomes are usually severalfold worse than after elective surgery, in terms of both morbidity and mortality. In addition, costs are considerable across the entire care pathway, with increases projected for the next few decades. In particular, the elderly are at higher risk of adverse outcomes as they have known, and often unknown, co‐morbidity that adds complexity to their care.…”

Section: Introductionmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2016

Journal of British Surgery

147

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Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

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“…(9, 11, 18, 19) Despite the increasing utilization of non-operative management in surgery, clinical outcomes related to non-operative management strategies are rarely evaluated. Diseases such as diverticulitis, SBO, cholecystitis, choledocholithiasis, and even appendicitis are being managed non-operatively at increasingly high rates.…”

Section: Discussionmentioning

confidence: 99%

“…(9) Despite the higher complication rates and increased costs associated with the acute management of surgical disease, widely accepted surgical quality initiatives do not currently focus on EGS. (10–12) Although the reasons for this are multi-factorial, challenges collecting data on patients managed non-operatively and difficulties providing adequately risk-adjusted performance feedback are likely key contributing factors.…”

Section: Introductionmentioning

confidence: 99%

Expanding the scope of quality measurement in surgery to include nonoperative care: Results from the American College of Surgeons National Surgical Quality Improvement Program emergency general surgery pilot

Wandling

Bankey

et al. 2017

J Trauma Acute Care Surg

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Background Patients managed non-operatively have been excluded from risk-adjusted benchmarking programs, including the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). Consequently, optimal performance evaluation is not possible for specialties like emergency general surgery (EGS) where non-operative management is common. We developed a multi-institutional EGS clinical data registry within ACS NSQIP that includes patients managed non-operatively to evaluate variability in non-operative care across hospitals and identify gaps in performance assessment that occur when only operative cases are considered. Methods Using ACS NSQIP infrastructure and methodology, surgical consultations for acute appendicitis, acute cholecystitis, and small bowel obstruction (SBO) were sampled at 13 hospitals that volunteered to participate in the EGS clinical data registry. Standard NSQIP variables and 16 EGS-specific variables were abstracted with 30-day follow-up. To determine the influence of complications in non-operative patients, rates of adverse outcomes were identified and hospitals were ranked by performance with and then without including non-operative cases. Results 2,091 patients with EGS diagnoses were included, 46.6% with appendicitis, 24.3% with cholecystitis, and 29.1% with SBO. The overall rate of non-operative management was 27.4%, 6.6% for appendicitis, 16.5% for cholecystitis, and 69.9% for SBO. Despite comprising only 27.4% of patients in the EGS Pilot, non-operative management accounted for 67.7% of deaths, 34.3% of serious morbidities, and 41.8% of hospital readmissions. After adjusting for patient characteristics and hospital diagnosis mix, addition of non-operative management to hospital performance assessment resulted in 12 of 13 hospitals changing performance rank, with 4 hospitals changing by 3 or more positions. Conclusions This study identifies a gap in performance evaluation when non-operative patients are excluded from surgical quality assessment and demonstrates the feasibility of incorporating non-operative care into existing surgical quality initiatives. Broadening the scope of hospital performance assessment to include non-operative management creates an opportunity to improve the care of all surgical patients, not just those who have an operation. Level of Evidence III, Prognostic and Epidemiological

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The financial burden of emergency general surgery

Abstract: Economic analysis, level III.

Cited by 180 publications

References 6 publications

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States

ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States

Emergency general surgery in the geriatric patient

Expanding the scope of quality measurement in surgery to include nonoperative care: Results from the American College of Surgeons National Surgical Quality Improvement Program emergency general surgery pilot

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