Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals

Angela M. Ingraham*, Mark E. Cohen, Karl Y Bilimoria, Joseph M Feinglass, Karen E. Richards, Bruce Lee Hall, Clifford Y. Ko

*Corresponding author for this work

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)155-165
Number of pages11
JournalJournal of the American College of Surgeons
Volume210
Issue number2
DOIs
StatePublished - Feb 1 2010

Fingerprint

Emergencies
Quality Improvement
Morbidity
Mortality
Logistic Models
Emergency Medical Services

ASJC Scopus subject areas

  • Surgery

Cite this

Ingraham, Angela M. ; Cohen, Mark E. ; Bilimoria, Karl Y ; Feinglass, Joseph M ; Richards, Karen E. ; Hall, Bruce Lee ; Ko, Clifford Y. / Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals. In: Journal of the American College of Surgeons. 2010 ; Vol. 210, No. 2. pp. 155-165.
@article{f809b079fb204f319999ccecf286eaf6,
title = "Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals",
abstract = "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.",
author = "Ingraham, {Angela M.} and Cohen, {Mark E.} and Bilimoria, {Karl Y} and Feinglass, {Joseph M} and Richards, {Karen E.} and Hall, {Bruce Lee} and Ko, {Clifford Y.}",
year = "2010",
month = "2",
day = "1",
doi = "10.1016/j.jamcollsurg.2009.10.016",
language = "English (US)",
volume = "210",
pages = "155--165",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals. / Ingraham, Angela M.; Cohen, Mark E.; Bilimoria, Karl Y; Feinglass, Joseph M; Richards, Karen E.; Hall, Bruce Lee; Ko, Clifford Y.

In: Journal of the American College of Surgeons, Vol. 210, No. 2, 01.02.2010, p. 155-165.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of Hospital Performance in Nonemergency Versus Emergency Colorectal Operations at 142 Hospitals

AU - Ingraham, Angela M.

AU - Cohen, Mark E.

AU - Bilimoria, Karl Y

AU - Feinglass, Joseph M

AU - Richards, Karen E.

AU - Hall, Bruce Lee

AU - Ko, Clifford Y.

PY - 2010/2/1

Y1 - 2010/2/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=74749104708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=74749104708&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2009.10.016

DO - 10.1016/j.jamcollsurg.2009.10.016

M3 - Article

C2 - 20113935

AN - SCOPUS:74749104708

VL - 210

SP - 155

EP - 165

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -