11.07 High Volume of Emergency General Surgery Cases Is Associated With Better Outcomes.

Posted on December 22, 2014

V. Pandit1, P. Rhee1, B. Zangbar1, N. Kulvatunyou1, M. Khalil1, T. O’Keeffe1, A. Tang1, D. J. Green1, G. Vercruysse1, R. S. Friese1, B. Joseph1  1University Of Arizona,Trauma/Surgery/Medicine,Tucson, AZ, USA

Introduction:
The impact of trauma center volume on patient outcomes is well established. With regionalization of emergency general surgical (EGS) care, the association between EGS case volume and patient outcomes remains unknown. The aim of this study was to evaluate the association between EGS case volume and outcomes across the centers in the United States.

Methods:
We abstracted the national estimates for EGS procedures from the National Inpatient Sample database 2011 (representing 20% of all in-patient admissions).  Patients undergoing emergent procedures (appendectomy, cholecystectomy, hernia repair, small and large bowel resections) were included. Centers were divided into two groups based on the number of EGS cases performed per year: High volume (> 350 cases) centers (HVC) and low volume (<350 cases) centers (LVC). Outcome measures were: in-hospital complications, hospital length of stay, failure to rescue rate, and mortality.  Regression analysis was performed controlling for age, gender, Charlson comorbidity index, and type of surgical procedure.

Results:
A total of 167,698 patients that underwent EGS procedures across 825 centers were included.  22.8% (n=188) centers were HVC. Patients managed in HVC had a lower complication rate (16.8% vs.17.2%; OR [95%CI]: 0.96 [0.91- 0.97], p=0.032) and a shorter hospital length of stay (5.8±4.1 vs. 6.2±5.4; OR [95%CI]: 0.95 [0.89- 0.96], p=0.041) compared to patients managed in LVC. On sub-analysis of patients with major complications (n= 4,516), HVC had a lower failure to rescue rate compared to LVC (24.8% vs.36.1%; OR [95%CI]: 0.91 [0.85- 0.96], p=0.021). There was no difference in overall mortality rate between the two groups. (2.5% vs. 2.4%; OR [95%CI]: 1.13 [0.05- 1.21], p=0.71).

Conclusion:
A volume effect relationship exists among centers managing EGS patients. High volume EGS centers have a lower complications rate and a lower failure to rescue rate compared to low volume EGS centers. Understanding the reasoning behind the volume impact in EGS cases is critical as we move forward with expanding the acute care surgery model.