Variation in Quality of Care after Emergency General Surgery Procedures in the Elderly
- 30 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 212 (6), 1039-1048
- https://doi.org/10.1016/j.jamcollsurg.2011.03.001
Abstract
Background The elderly (age ≥65 years) comprise an increasing proportion of patients undergoing emergency general surgery (EGS) procedures and have distinct needs compared with the young. We postulated that the needs of the elderly require different processes of care than those required for the young to assure optimal outcomes. To explore this hypothesis, we evaluated 30-day outcomes following EGS procedures in the young and the elderly and determined whether hospital performance was consistent across these 2 age strata. Study Design With data from the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2008), regression models were constructed for serious morbidity and mortality for all patients undergoing EGS procedures and separately for young and elderly patients. These models allowed for estimation of the risk of adverse outcomes associated with advanced age and the generation of hospital-level observed to expected (O/E) ratios. We evaluated the correlation between hospital O/E ratios for the young and the elderly and the concordance of outlier status (hospitals with CIs of O/E ratios excluding 1) with weighted κ across these 2 age groups. Results Among 68,003 procedures at 186 hospitals, elderly patients had a higher crude and adjusted risk for serious morbidity (27.9% versus 9.7%, p < 0.0001; odds ratio 1.17, 95% CI 1.10 to 1.24) and mortality (15.2% versus 2.5%, p < 0.0001; odds ratio 2.29, 95% CI 2.09 to 2.51). When outcomes for elderly versus younger patients were compared, there was fair to moderate agreement on hospital performance for serious morbidity (r = 0.43; κ = 0.30) but not for mortality (r = 0.10; κ = 0.17). Conclusions Elderly patients are at substantially greater risk for adverse events following EGS procedures. Hospitals had only slight agreement in mortality outcomes in the elderly compared with those in young patients. Processes of care that may account for this disparity should be further investigated.Keywords
This publication has 25 references indexed in Scilit:
- External Benchmarking of Trauma Center PerformanceAnnals of Surgery, 2011
- Variation in Hospital Mortality Associated with Inpatient SurgeryThe New England Journal of Medicine, 2009
- Comparison of Commission on Cancer–Approved and –Nonapproved Hospitals in the United States: Implications for Studies That Use the National Cancer Data BaseJournal of Clinical Oncology, 2009
- Developing Quality Indicators for Elderly Surgical PatientsAnnals of Surgery, 2009
- Directing Surgical Quality Improvement Initiatives: Comparison of Perioperative Mortality and Long-Term Survival for Cancer SurgeryJournal of Clinical Oncology, 2008
- The Patient Safety in Surgery Study: Background, Study Design, and Patient PopulationsJournal of the American College of Surgeons, 2007
- Surgical Risk Factors, Morbidity, and Mortality in Elderly PatientsJournal of the American College of Surgeons, 2006
- The NSQIP: A new frontier in surgerySurgery, 2005
- Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderlyBritish Journal of Surgery, 1998
- A Simple Method for Calculating the Exact Confidence Interval of the Standardized Mortality Ratio with an SAS FunctionJournal of Occupational Health, 1996