Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals
Presented at the 95th Annual American College of Surgeons Clinical Congress, Surgical Forum, Chicago, IL, October 2009.
Received 13 August 2009; received in revised form 26 October 2009; accepted 27 October 2009. published online 24 December 2009.
Background
Quality improvement efforts have demonstrated considerable hospital-to-hospital variation in surgical outcomes. However, information about the quality of emergency surgical care is lacking. The objective of this study was to assess whether hospitals have comparable outcomes for emergency and nonemergency operations.
Study Design
Patients undergoing colorectal resections were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2005 to 2007 dataset. Logistic regression models for 30-day morbidity and mortality after emergency and nonemergency colorectal resections were constructed. Hospital risk-adjusted outcomes as measured by observed to expected (O/E) ratios, outlier status, and rank-order differences were compared.
Results
Of 25,710 nonemergency colorectal resections performed at 142 ACS NSQIP hospitals, 6,138 (23.9%) patients experienced at least 1 complication, and 492 (1.9%) patients died. There were 5,083 emergency colorectal resections; 2,442 (48%) patients experienced at least 1 complication, and 780 (15.3%) patients died. Outcomes for nonemergency versus emergency operations were weakly correlated for morbidity and mortality (Pearson correlation coefficient: 0.28 versus 0.13). Median differences in hospital rankings based on O/E ratios between nonemergency and emergency performance were 30.5 ranks (interquartile range [IQR] 13 to 59) for morbidity and 34 ranks (interquartile ratio 17 to 61) for mortality.
Conclusions
Hospitals with favorable outcomes after nonemergency colorectal resections do not necessarily have similar outcomes for emergency operations. Hospitals should specifically examine their performance on emergency surgical procedures to identify quality improvement opportunities and focus quality improvement efforts appropriately.
aDivision of Research and Optimal Patient Care, American College of Surgeons, Northwestern University Feinberg School of Medicine, Chicago, IL
bDepartment of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
cDivision of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
dDepartment of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
eDepartment of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, MO
fDepartment of Surgery, School of Medicine, Washington University in St Louis and Barnes-Jewish Hospital, St Louis, MO
gOlin School of Business and the Center for Health Policy, Washington University in St Louis, St Louis, MO
hDepartment of Surgery, University of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare System, Los Angeles, CA
Correspondence address: Angela M Ingraham, MD, American College of Surgeons, 633 N St Clair St, Floor 22NE, Chicago, IL 60611
Disclosure Information: Nothing to disclose.
Dr Ingraham is supported by the Clinical Scholar in Residence Program at the American College of Surgeons. Dr Hall is supported by the Center for Health Policy, Washington University in St Louis. Dr Bilimoria is supported by a Priority Grant from Northwestern University.
ABSTRACT