Emergency General Surgery Outcomes: A Reliable Predictor of Hospital-Level Performance

Background Efforts to explain the causes of variation in emergency general surgery (EGS) outcomes have focused on surgeon-level factors such as technical proficiency and individual caseload. The present work examined the association of institutional structure and hospital-wide quality with outcomes of EGS operations. Study design Adult EGS admissions (large bowel resection, small bowel resection, repair of perforated ulcer, lysis of peritoneal adhesions, and laparotomy) were identified in the 2022 Nationwide Readmission Database. Hierarchical mixed-effects models were developed to assess center-level rates of the major adverse events (MAEs) for each EGS procedure. Low-Performing Hospitals (LPH) were defined as centers demonstrating the highest decile of MAE risk. Multivariable regression models examined associations between EGS outcomes and center quality, as measured by hospital-level rates of acute myocardial infarction (AMI) mortality. Results Of an estimated 139,543 patients undergoing EGS, 12,314 (8.8%) were admitted to an LPH. Treatment at an LPH was linked to 2.44-fold greater odds of MAE (95% Cl 2.25-2.63). In both LPH and non-LPH, the MAE rates for individual operations were strongly correlated with those of other EGS procedures. Furthermore, the mortality rate for AMI revealed significantly positive correlation with EGS MAE across all centers (r = 0.24, P < .05). Conclusion Consistent underperformance across operations at LPH emphasizes the influence of broader institutional factors in addition to procedure-specific expertise on outcomes. The strong correlation between the rates of EGS MAE and AMI mortality may point to the presence of structural factors that persist across service lines and serve as suitable targets for quality improvement.