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Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery.

Publication ,  Journal Article
Scarborough, JE; Schumacher, J; Pappas, TN; McCoy, CC; Englum, BR; Agarwal, SK; Greenberg, CC
Published in: J Am Coll Surg
April 2016

BACKGROUND: Because preoperative risk factor modification is generally not possible in the emergency setting, complication prevention represents an important focus for quality improvement in emergency general surgery (EGS). The objective of our study was to determine the overall impact that specific postoperative complications have in this patient population. STUDY DESIGN: Our study sample consisted of patients from the 2012-2013 ACS-NSQIP database who underwent an EGS procedure. We used population attributable fractions (PAFs) to estimate the overall impact that each of 8 specific complications had on 30-day physiologic and resource use outcomes in our study population. The PAF represents the percentage reduction in a given outcome that would be anticipated if a complication were able to be completely prevented in our study population. Both unadjusted and risk-adjusted PAFs were calculated. RESULTS: There were 79,183 patients included for analysis. The most common complications in these patients were bleeding (6.2%), incisional surgical site infection (SSI) (3.4%), pneumonia (2.7%), and organ/space SSI (2.6%). Bleeding was the complication with the greatest overall impact on mortality and end-organ dysfunction, demonstrating an adjusted PAF of 10.7% (95% CI 8.2%,13.1%, p < 0.001) and 15.9% (95% CI 13.9%, 16.7%, p < 0.001) for these respective outcomes. The only other complication with a sizeable impact on these outcomes was pneumonia (adjusted PAF of 7.9% for mortality and 13.2% for pneumonia). In contrast, complications such as urinary tract infection, venous thromboembolism, myocardial infarction, and incisional SSI had negligible impacts on these outcomes. CONCLUSIONS: Our study provides a framework for the development of high-value quality initiatives in EGS.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

April 2016

Volume

222

Issue

4

Start / End Page

515 / 524

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Hemorrhage
  • Pneumonia
  • Middle Aged
  • Male
  • Humans
 

Citation

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Scarborough, J. E., Schumacher, J., Pappas, T. N., McCoy, C. C., Englum, B. R., Agarwal, S. K., & Greenberg, C. C. (2016). Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery. J Am Coll Surg, 222(4), 515–524. https://doi.org/10.1016/j.jamcollsurg.2015.12.038
Scarborough, John E., Jessica Schumacher, Theodore N. Pappas, Christopher C. McCoy, Brian R. Englum, Suresh K. Agarwal, and Caprice C. Greenberg. “Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery.J Am Coll Surg 222, no. 4 (April 2016): 515–24. https://doi.org/10.1016/j.jamcollsurg.2015.12.038.
Scarborough JE, Schumacher J, Pappas TN, McCoy CC, Englum BR, Agarwal SK, et al. Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery. J Am Coll Surg. 2016 Apr;222(4):515–24.
Scarborough, John E., et al. “Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery.J Am Coll Surg, vol. 222, no. 4, Apr. 2016, pp. 515–24. Pubmed, doi:10.1016/j.jamcollsurg.2015.12.038.
Scarborough JE, Schumacher J, Pappas TN, McCoy CC, Englum BR, Agarwal SK, Greenberg CC. Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery. J Am Coll Surg. 2016 Apr;222(4):515–524.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

April 2016

Volume

222

Issue

4

Start / End Page

515 / 524

Location

United States

Related Subject Headings

  • United States
  • Surgical Wound Infection
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Hemorrhage
  • Pneumonia
  • Middle Aged
  • Male
  • Humans