Reconceptualizing High-Quality Emergency General Surgery Care: Non-Mortality-Based Quality-Metrics Enable Meaningful and Consistent Assessment. The journal of trauma and acute care surgery Zogg, C. K., Staudenmayer, K. L., Kodadek, L. M., Davis, K. A. 2022


BACKGROUND: Ongoing efforts to promote quality-improvement in emergency general surgery (EGS) have made substantial strides but lack clear definitions of what constitutes "high-quality" EGS care. To address this concern, we developed a novel set of five non-mortality-based quality-metrics broadly applicable to the care of all EGS patients and sought to discern whether: (1) they can be used to identify groups of best-performing EGS hospitals, (2) results are similar for simple versus complex EGS severity in both adult (18-64 years) and older adult (=65 years) populations, and (3) best performance is associated with differences in hospital-level factors.METHODS: Patients hospitalized with 1-of-16 AAST-defined EGS conditions were identified in the 2019 Nationwide Readmissions Database. They were stratified by age/severity into four cohorts: simple adults, complex adults, simple older adults, complex older adults. Within each cohort, risk-adjusted hierarchical models were used to calculate condition-specific risk-standardized quality-metrics. K-means cluster analysis identified hospitals with similar performance, and multinomial regression identified predictors of resultant "best/average/worst" EGS care.RESULTS: 1,130,496 admissions from 984 hospitals were included (40.6% simple adults, 13.5% complex adults, 39.5% simple older adults, 6.4% complex older adults). Within each cohort, K-means cluster analysis identified three groups ("best/average/worst"). Cluster assignment was highly conserved with 95.3% of hospitals assigned to the same cluster in each cohort. It was associated with consistently best/average/worst performance across differences in outcomes (5x) and EGS conditions (16x). When examined for associations with hospital-level factors, best-performing hospitals were those with the largest EGS volume, greatest extent of patient frailty, and most complicated underlying patient case-mix.CONCLUSION: Use of non-mortality-based quality-metrics appears to offer a needed, promising means of evaluating high-quality EGS care. The results underscore the importance of accounting for outcomes applicable to all EGS patients when designing quality-improvement initiatives and suggest that, given the consistency of best-performing hospitals, natural EGS centers-of-excellence could exist.LEVEL OF EVIDENCE: Prognostic and Epidemiological, Level III.

View details for DOI 10.1097/TA.0000000000003818

View details for PubMedID 36245079