Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Res. 2021 May;261:1-9. doi: 10.1016/j.jss.2020.11.086. Epub 2020 Dec 30.
Center-level outcome metrics have long been tracked in elective surgery (ELS). Despite recent interest in measuring emergency general surgery (EGS) quality, centers are often compared based on elective or combined outcomes. Therefore, quality of care for emergency surgery specifically is unknown.
We extracted data on EGS and ELS patients from the 2016 State Inpatient Databases of Florida, New York, and Kentucky. Centers that performed >100 ELS and EGS operations were included. Risk-adjusted mortality, complication, and failure to rescue (FTR, death after complication) rates were calculated and observed-to-expected ratios were calculated by center for ELS and EGS patients. Centers were determined to be high or low outliers if the 90% CI for the observed: expected ratio excluded 1. We calculated the frequency with which centers demonstrated a different performance status between EGS and ELS. Kendall's tau values were calculated to assess for correlation between EGS and ELS status.
A total of 204 centers with 45,500 EGS cases and 49,380 ELS cases met inclusion criteria. Overall mortality, complication, and FTR rates were 1.7%, 8.0%, and 14.5% respectively. There was no significant correlation between mortality performance in EGS and ELS, with 36 centers in a different performance category (high outlier, low outlier, as expected) in EGS than in ELS. The correlation for complication rates was 0.20, with 60 centers in different categories for EGS and ELS. For FTR rates, there was no correlation, with 16 centers changing category.
There was minimal correlation between outcomes for ELS and EGS. High performers in one category were rarely high performers in the other. There may be important differences between the processes of care that are important for EGS and ELS outcomes that may yield meaningful opportunities for quality improvement.
中心层面的结果指标在择期手术（ELS）中一直受到关注。尽管最近对测量急诊普通外科（EGS）质量的兴趣有所增加，但通常是根据择期或联合结果来比较中心。因此，具体急诊手术的护理质量尚不清楚。
我们从佛罗里达州、纽约州和肯塔基州的 2016 年州住院数据库中提取了 EGS 和 ELS 患者的数据。纳入了开展>100 例 ELS 和 EGS 手术的中心。计算了风险调整后的死亡率、并发症和抢救失败率（FTR，并发症后死亡），并计算了 ELS 和 EGS 患者的中心观察到的与预期的比率。如果观察到的：预期比率的 90%置信区间排除了 1，则中心被确定为高或低异常值。我们计算了中心在 EGS 和 ELS 之间表现出不同绩效状态的频率。计算 Kendall tau 值以评估 EGS 和 ELS 状态之间的相关性。
共有 204 个中心，共 45500 例 EGS 病例和 49380 例 ELS 病例符合纳入标准。总死亡率、并发症和 FTR 发生率分别为 1.7%、8.0%和 14.5%。EGS 中的死亡率表现与 ELS 之间没有显著相关性，36 个中心在 EGS 中的绩效类别（高异常值、低异常值、预期）与 ELS 不同。并发症发生率的相关性为 0.20，有 60 个中心在 EGS 和 ELS 的类别不同。对于 FTR 率，没有相关性，有 16 个中心改变了类别。
ELS 和 EGS 的结果之间相关性极小。在一个类别中表现出色的很少在另一个类别中表现出色。EGS 和 ELS 结果的护理过程可能存在重要差异，这可能为质量改进提供有意义的机会。
