INTRODUCTION: Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. METHODS: We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. RESULTS: Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). CONCLUSIONS: Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.
INTRODUCTION: Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan. METHODS: We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance]. RESULTS: Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%). CONCLUSIONS: Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.
Authors: Mauro Moscucci; David Share; Eva Kline-Rogers; Michael O'Donnell; Ann Maxwell-Eward; William L Meengs; Vivian L Clark; Phillip Kraft; Anthony C De Franco; James L Chambers; Kirit Patel; John G McGinnity; Kim A Eagle Journal: J Interv Cardiol Date: 2002-10 Impact factor: 2.279
Authors: Michael J Englesbe; Justin B Dimick; Christopher J Sonnenday; David A Share; Darrell A Campbell Journal: Ann Surg Date: 2007-12 Impact factor: 12.969
Authors: G T O'Connor; H B Quinton; N D Traven; L D Ramunno; T A Dodds; T A Marciniak; J E Wennberg Journal: JAMA Date: 1999-02-17 Impact factor: 56.272
Authors: Darrell A Campbell; William G Henderson; Michael J Englesbe; Bruce L Hall; Michael O'Reilly; Dale Bratzler; E Patchen Dellinger; Leigh Neumayer; Barbara L Bass; Matthew M Hutter; James Schwartz; Clifford Ko; Kamal Itani; Steven M Steinberg; Allan Siperstein; Robert G Sawyer; Douglas J Turner; Shukri F Khuri Journal: J Am Coll Surg Date: 2008-10-10 Impact factor: 6.113
Authors: G T O'Connor; S K Plume; E M Olmstead; J R Morton; C T Maloney; W C Nugent; F Hernandez; R Clough; B J Leavitt; L H Coffin; C A Marrin; D Wennberg; J D Birkmeyer; D C Charlesworth; D J Malenka; H B Quinton; J F Kasper Journal: JAMA Date: 1996-03-20 Impact factor: 56.272
Authors: John E Scarborough; Jessica Schumacher; Theodore N Pappas; Christopher C McCoy; Brian R Englum; Suresh K Agarwal; Caprice C Greenberg Journal: J Am Coll Surg Date: 2016-01-14 Impact factor: 6.113
Authors: Kyle H Sheetz; Robert W Krell; Michael J Englesbe; John D Birkmeyer; Darrell A Campbell; Amir A Ghaferi Journal: J Am Coll Surg Date: 2014-05-09 Impact factor: 6.113
Authors: Naveen F Sangji; Jordan D Bohnen; Elie P Ramly; George C Velmahos; David C Chang; Haytham M A Kaafarani Journal: World J Surg Date: 2017-07 Impact factor: 3.352
Authors: Samuel W Ross; Kali M Kuhlenschmidt; John C Kubasiak; Lindsey E Mossler; Luis R Taveras; Thomas H Shoultz; Herbert A Phelan; Caroline E Reinke; Michael W Cripps Journal: JAMA Surg Date: 2020-06-01 Impact factor: 14.766
Authors: Diane A Schwartz; Xuan Hui; Catherine G Velopulos; Eric B Schneider; Shalini Selvarajah; Donald Lucas; Elliott R Haut; Nathaniel McQuay; Timothy M Pawlik; David T Efron; Adil H Haider Journal: J Trauma Acute Care Surg Date: 2014-01 Impact factor: 3.313
Authors: Matthew G Mullen; Alex D Michaels; J Hunter Mehaffey; Christopher A Guidry; Florence E Turrentine; Traci L Hedrick; Charles M Friel Journal: JAMA Surg Date: 2017-08-01 Impact factor: 14.766