Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Kaufman, Elinore J.; Keele, Luke; Wirtalla, Christopher; Rosen, Claire; Roberts, Sanford E.; Mavroudis, Catherine L.; Reilly, Patrick; Holena, Daniel N.; McHugh, Matthew D.; Small, Dylan S.; Kelz, Rachel R.

doi:10.1097/sla.0000000000005519

Cited by 16 publications

(38 citation statements)

References 44 publications

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“…Sensitivity analyses and their results are included in Supplemental Table 2 and Supplemental Section 3, http://links.lww.com/MLR/C678). The strength and validity of our preference-based IV has been previously described in our prior works 13,23,24 . A detailed description of our IV statistical model is provided in Supplemental Section 5, http://links.lww.com/MLR/C678.…”

Section: Methodsmentioning

confidence: 93%

“…These patients are given no weight in the IV estimate. Thus, the IV estimate is a weighted average that only weights outcomes for patients for whom different surgeons would have chosen a different course of treatment 13,23,24 …”

Section: Methodsmentioning

confidence: 99%

“…To address these issues, an instrumental variable (IV) can be utilized to account for unmeasured sources of bias and confounding. In our previous work, we have examined the impact of operative and nonoperative management on outcomes within EGS using an IV analysis for patients of all racial backgrounds 13 . To date, it is unknown how the decision to operate versus manage nonoperatively differentially affects Black and White patients for whom the decision to operate is in equipoise with the decision to manage nonoperatively.…”

mentioning

confidence: 99%

“…In our previous work, we have examined the impact of operative and nonoperative management on outcomes within EGS using an IV analysis for patients of all racial backgrounds. 13 To date, it is unknown how the decision to operate versus manage nonoperatively differentially affects Black and White patients for whom the decision to operate is in equipoise with the decision to manage nonoperatively. To address this gap in knowledge, this study uses an IV analysis to determine the conditional effect of race on the outcomes of patients with EGS conditions.…”

mentioning

confidence: 99%

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Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Roberts¹,

Rosen²,

Keele³

et al. 2023

Medical Care

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Introduction: Many emergency general surgery (EGS) conditions can be managed both operatively or nonoperatively; however, it is unknown whether the decision to operate affects Black and White patients differentially. Methods: We identified a nationwide cohort of Black and White Medicare beneficiaries, hospitalized for common EGS conditions from July 2015 to June 2018. Using near-far matching to adjust for measurable confounding and an instrumental variable analysis to control for selection bias associated with treatment assignment, we compare outcomes of operative and nonoperative management in a stratified population of Black and White patients. Outcomes included in-hospital mortality, 30-day mortality, nonroutine discharge, and 30-day readmissions. An interaction test based on a t test was used to determine the conditional effects of operative versus nonoperative management between Black and White patients. Results: A total of 556,087 patients met inclusion criteria, of which 59,519 (10.7%) were Black and 496,568 (89.3%) were White. Overall, 165,932 (29.8%) patients had an operation and 390,155 (70.2%) were managed nonoperatively. Significant outcome differences were seen between operative and nonoperative management for some conditions; however, no significant differences were seen for the conditional effect of race on outcomes. Conclusions: The decision to manage an EGS patient operatively versus nonoperatively has varying effects on surgical outcomes. These effects vary by EGS condition. There were no significant conditional effects of race on the outcomes of operative versus nonoperative management among universally insured older adults hospitalized with EGS conditions.

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Section: Methodsmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Roberts¹,

Rosen²,

Keele³

et al. 2023

Medical Care

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“…12 For each design, examples beyond those in the narrative may be found in Table 1. [13][14][15][16][17][18][19][20][21][22]…”

Section: Novel Analytic Techniquesmentioning

confidence: 99%

Quasi-Experimental Design for Health Policy Research: A Methodology Overview

Fahmy

Cichocki

Chung

2022

Plastic &Amp; Reconstructive Surgery

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Summary: Health policy impacts all aspects of the authors’ field. Research on this topic informs future policy direction and serves as an impactful means to advocate for their patients. The present work aims to promote policy research in plastic surgery. To accomplish this goal, the authors discuss quasi-experimental research design. The authors include in-depth discussion regarding study techniques that are well suited to health policy, including interrupted time series, difference-in-differences analysis, regression discontinuity design, and instrumental variable design. For each study design, the authors discuss examples and potential limitations.

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Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions

Moneme,

Wirtalla,

Roberts

et al. 2023

JAMA Surg

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ImportanceThe benefit of primary care physician (PCP) follow-up as a potential means to reduce readmissions in hospitalized patients has been found in other medical conditions and among patients receiving high-risk surgery. However, little is known about the implications of PCP follow-up for patients with an emergency general surgery (EGS) condition.ObjectiveTo evaluate the association between PCP follow-up and 30-day readmission rates after hospital discharge for an EGS condition.Design, Setting, and ParticipantsThis cohort study used data from the Centers for Medicare &amp; Medicaid Services Master Beneficiary Summary File, Inpatient, Carrier (Part B), and Durable Medical Equipment files for beneficiaries aged 66 years or older who were hospitalized with an EGS condition that was managed operatively or nonoperatively between September 1, 2016, and November 30, 2018. Eligible patients were enrolled in Medicare fee-for-service, admitted through the emergency department with a primary diagnosis of an EGS condition, and received a general surgery consultation during the admission. Data were analyzed between July 11, 2022, and June 5, 2023.ExposureFollow-up with a PCP within 30 days after hospital discharge for the index admission.Main Outcomes and MeasuresThe primary outcome was readmission within 30 days after discharge for the index admission. An inverse probability weighted regression model was used to estimate the risk-adjusted association of PCP follow-up with 30-day readmission. The secondary outcome was readmission within 30 days after discharge stratified by treatment type (operative vs nonoperative treatment) during their index admission.ResultsThe study included 345 360 Medicare beneficiaries (mean [SD] age, 74.4 [12.0] years; 187 804 females [54.4%]) hospitalized with an EGS condition. Of these, 156 820 patients (45.4%) had a follow-up PCP visit, 108 544 (31.4%) received operative treatment during their index admission, and 236 816 (68.6%) received nonoperative treatment. Overall, 58 253 of 332 874 patients (17.5%) were readmitted within 30 days after discharge for the index admission. After risk adjustment and propensity weighting, patients who had PCP follow-up had 67% lower odds of readmission (adjusted odds ratio [AOR], 0.33; 95% CI, 0.31-0.36) compared with patients without PCP follow-up. After stratifying by treatment type, patients who were treated operatively during their index admission and had subsequent PCP follow-up within 30 days after discharge had 79% reduced odds of readmission (AOR, 0.21; 95% CI, 0.18-0.25); a similar association was seen among patients who were treated nonoperatively (AOR, 0.36; 95% CI, 0.34-0.39). Infectious conditions, heart failure, acute kidney failure, and chronic kidney disease were among the most frequent diagnoses prompting readmission overall and among operative and nonoperative treatment groups.Conclusions and RelevanceIn this cohort study, follow-up with a PCP within 30 days after discharge for an EGS condition was associated with a significant reduction in the adjusted odds of 30-day readmission. This association was similar for patients who received operative care or nonoperative care during their index admission. In patients aged 66 years or older with an EGS condition, primary care coordination after discharge may be an important tool to reduce readmissions.

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Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Cited by 16 publications

References 44 publications

Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Conditional Effects of Race on Operative and Nonoperative Outcomes of Emergency General Surgery Conditions

Quasi-Experimental Design for Health Policy Research: A Methodology Overview

Primary Care Physician Follow-Up and 30-Day Readmission After Emergency General Surgery Admissions

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