Journal of the American College of Surgeons
Volume 210, Issue 2 , Pages 155-165, February 2010

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.

  • Angela M. Ingraham, MD

      Affiliations

    • Division of Research and Optimal Patient Care, American College of Surgeons, Northwestern University Feinberg School of Medicine, Chicago, IL
    • Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
    • Corresponding Author InformationCorrespondence address: Angela M Ingraham, MD, American College of Surgeons, 633 N St Clair St, Floor 22NE, Chicago, IL 60611
    • ,
  • Mark E. Cohen, PhD

      Affiliations

    • Division of Research and Optimal Patient Care, American College of Surgeons, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Karl Y. Bilimoria, MD, MS

      Affiliations

    • Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Joseph M. Feinglass, PhD

      Affiliations

    • Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Karen E. Richards, BS

      Affiliations

    • Division of Research and Optimal Patient Care, American College of Surgeons, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Bruce Lee Hall, MD, PhD, MBA, FACS

      Affiliations

    • Department of Surgery, John Cochran Veterans Affairs Medical Center, St Louis, MO
    • Department of Surgery, School of Medicine, Washington University in St Louis and Barnes-Jewish Hospital, St Louis, MO
    • Olin School of Business and the Center for Health Policy, Washington University in St Louis, St Louis, MO
    • ,
  • Clifford Y. Ko, MD, MS, MSHS, FACS

      Affiliations

    • Division of Research and Optimal Patient Care, American College of Surgeons, Northwestern University Feinberg School of Medicine, Chicago, IL
    • Department of Surgery, University of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare System, Los Angeles, CA

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.

Abbreviations and Acronyms: ACS NSQIP, American College of Surgeons National Surgical Quality Improvement Program, IQR, interquartile range, O/E, observed to expected, RR, relative risk, SSI, surgical site infection

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 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.

PII: S1072-7515(09)01549-X

doi:10.1016/j.jamcollsurg.2009.10.016

Journal of the American College of Surgeons
Volume 210, Issue 2 , Pages 155-165, February 2010

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