Surgeon-driven variability in emergency general surgery outcomes: Does it matter who is on call?

Surgery
Rhea UdyavarAdil H Haider

Abstract

Hospital-level variation has been found to influence outcomes in emergency general surgery. However, whether the individual surgeon plays a role in this variation is unknown. We performed an analysis of the Florida State Inpatient Database (2010-2014), which is linked to the American Hospital Association's Annual Survey Database, including patients who emergently underwent 1 or more of 7 procedures (laparotomy, adhesiolysis, small bowel resection, colectomy, repair of a perforated gastric ulcer, appendectomy, or cholecystectomy). We used multilevel random effects modeling to quantify the amount of variation in mortality, complications, and 30-day readmissions attributable to surgeons. Patient clinical and demographic factors, as well as hospital-level factors, were introduced into the model in a forward stepwise fashion, and the percent of the variation attributable to surgeons was derived. Our study included 2,149 surgeons across 224 hospitals, with a total of 569,767 emergency general surgery cases. The overall unadjusted mortality rate was 3.8%, and the complication and readmission rates were 12.7% and 27.7%, respectively. Surgeon-level variation had the greatest impact on mortality, explaining 32.77% of the overall variabil...Continue Reading

Citations

Jul 8, 2019·International Journal of Epidemiology·David MetcalfeDaniel C Perry
Jun 28, 2019·Trauma Surgery & Acute Care Open·Heena SantryMarie Crandall
May 28, 2020·The Journal of Trauma and Acute Care Surgery·Charles A MouchMark R Hemmila
Jul 17, 2020·Surgical Endoscopy·William SherrillCaroline E Reinke
Mar 7, 2020·Current Problems in Surgery·Alice WangTheodore N Pappas
Mar 11, 2021·JAMA Surgery·Kevin M SchusterBishwajit Bhattacharya

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