COMMENTARY

Urgent Surgical Procedures: Does It Matter Who Is On Call?

Albert B. Lowenfels, MD

Disclosures

December 14, 2018

The aim of a study recently published in Surgery was to measure whether the individual surgeon plays a role in the variability in outcomes among patients admitted to a hospital for an urgent surgical procedure.

The authors reviewed stored administrative data from 224 Florida hospitals containing results of over 500,000 emergency surgical operations performed by 2149 surgeons. Multivariate techniques were used to tease out the impact of the surgeon on mortality, complications, and readmission rates.

The results confirmed existing information about the importance of age and comorbidity on outcome, but they also revealed that volume of procedures performed by the surgeon had a measurable effect on outcome. For peptic ulcer disease surgery, a low-volume procedure, about half of patient mortality could be attributed to the individual surgeon; for lysis of adhesions, another relatively rare condition, surgical contribution explained about a third of all mortality differences.

Viewpoint

This report explains what is often suspected: For patients requiring urgent surgical care, surgical experience contributes to the outcome. This was particularly evident when looking at mortality data, and less so for complications or readmission rates. The impact of the surgeon was especially noted for relatively low-volume procedures such as peptic ulcer disease surgery, where medical treatment has reduced the need for surgery.

On the basis of the results of this large, retrospective study, the surgical contribution to patient outcome is another independent factor for postoperative mortality and morbidity, in addition to patient age, race, insurance coverage, or the presence of comorbidity.

Because the conclusions are based on administrative data, helpful information, such as patient delay, was unavailable. The article addresses a challenge: In this era of surgical specialization, how can we continue to provide the best care for patients with emergency general surgery conditions? Will acute care surgery become a separate specialty?

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