R. Udyavar1, A. Salim1, J. M. Havens1, T. Uribe Leitz1, G. Jin1, A. H. Haider1 1Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA
Introduction:
Although the Acute Care Surgery model has gained wide acceptance among hospitals nationwide, patients with emergency general surgery (EGS) diagnoses are cared for by surgeons with variable skill sets and training. We sought to identify the specialties of surgeons treating EGS patients, and characterize the relationship between surgeon specialty and outcomes.
Methods:
Retrospective cohort study examining EGS cases from the Florida State Inpatient Database (SID), 2010-2014. AHA database linkage provided hospital-level variables. Adult patients admitted emergently for seven conditions that account for 80% of the national EGS burden (includes appendicitis, cholecystitis, bowel obstruction, ulcer disease, and conditions leading to colectomy, adhesiolysis, and laparotomy). Surgeon specialty was designated by the proportion of non-EGS cases comprising each surgeon’s annual caseload. Our outcome measures were in-hospital mortality and major complications, adjusting for diagnosis, age, sex, comorbidities, procedures, hospital and surgeon case volume, trauma center designation, teaching status, and bed size were compared among patients treated by general surgeons (who took no trauma call), Trauma/Acute Care surgeons (TACS), and sub-specialists.
Results:
Of the 5,611 surgeons, the majority were general or TACS (see Table). Significant differences in odds of mortality were noted between the reference group (non-trauma general surgeons) and all sub-specialists. Odds of complications were higher among vascular and colorectal surgeons.
Conclusion:
In Florida, EGS care is mostly provided by general surgeons or TACS. Odds of mortality among patients treated by non-trauma general surgeons exceeded those treated by all sub-specialists. Further work is needed to uncover the individual and system-level factors explaining these differences.
