T. C. Tsai1,2, L. Burke2,3, M. J. Zinner1 1Brigham And Women’s Hospital,Surgery,Boston, MA, USA 2Harvard School Of Public Health,Health Policy And Management,Boston, MA, USA 3Beth Israel Deaconess Medical Center,Emergency Medicine,Boston, MA, USA
Introduction:
A significant proportion elderly patients undergoing emergency general surgery are admitted through emergency departments (ED). However, quality efforts aimed at improving outcomes for these patients have focused primarily on intra-operative and post-operative processes of surgical care. Little is known on whether the quality of emergency department care is related to postsurgical outcomes. We therefore assessed whether low-quality EDs were associated with worse perioperative outcomes for elderly emergency general surgery patients.
Methods:
We used the percentage of stroke patients receiving a head computed tomography (CT) scan within 45 minutes, a Centers for Medicare and Medicaid Services (CMS) publicly reported measure, as our measure of ED quality. Using 2012 national Medicare inpatient claims, we calculated risk-adjusted 30-day mortality rates for elderly patients admitted through the ED and undergoing the following emergent operations: appendectomy, cholecystectomy, inguinal hernia, exploratory laparotomy, colectomy, and small bowel resection. We then used a multivariate regression model adjusting for hospital features to assess the relationship between ED quality and acute care surgery outcomes.
Results:
648 hospitals publicly reported their head CT process quality measure in 2012. 15.5% of patients received timely and appropriate imaging in low-quality EDs compared to 79.9% of patients in high-quality EDs (p<0.001). Compared to high-quality EDs, low-quality EDs were more likely to be small (32.1% vs. 18,7%, p<0.001), located in the South (47.3% vs. 30.7%, p<0.001), and publicly owned (24.2% vs. 10.0%, p<0.001). Adjusting for hospital features, low-quality EDs were associated with higher 30-day surgical mortality (14.0% vs. 9.1%, p=0.019).
Conclusion:
Emergency care plays an important role in determining the outcomes of surgical patients. Hospitals with worse performance on publicly reported ED quality measures also have higher 30-day mortality for emergency surgical patients. An emphasis on high-quality emergency care is critical for optimal outcomes of surgical patients.