2023
Emergency general surgery verification: Quality improvement and the case for optimal resources and process standards
Coleman J, Davis K, Savage S, Staudenmayer K, Coimbra R. Emergency general surgery verification: Quality improvement and the case for optimal resources and process standards. Journal Of Trauma And Acute Care Surgery 2023, 96: e1-e4. PMID: 37678150, DOI: 10.1097/ta.0000000000004135.Peer-Reviewed Original ResearchMeSH KeywordsEmergenciesGeneral SurgeryHospitalsHumansPostoperative ComplicationsQuality ImprovementRegistriesRetrospective StudiesSurgical Procedures, OperativeConceptsEmergency general surgeryEmergency surgical interventionDay of surgeryAcute care surgeryPublic health burdenQuality Improvement ProgramPostoperative complicationsCare surgeryHospital admissionIll patientsSurgical interventionFormal quality improvement programHealth burdenGeneral surgeryPatient careCare deliverySurgeryPrograms/servicesField of traumaOutcomes researchPatientsAdmissionHospitalNational databankPractice standards
2020
Geographic Variation in the Utilization of and Mortality After Emergency General Surgery Operations in the Northeastern and Southeastern United States
Becher RD, Jin L, Warren JL, Gill TM, DeWane MP, Davis KA, Zhang Y. Geographic Variation in the Utilization of and Mortality After Emergency General Surgery Operations in the Northeastern and Southeastern United States. Annals Of Surgery 2020, 275: 340-347. PMID: 32516232, PMCID: PMC7726051, DOI: 10.1097/sla.0000000000003939.Peer-Reviewed Original ResearchConceptsHospital service areasSubsequent mortalityEmergency general surgery careEmergency general surgery operationsEGS operationsCommon EGS operationsAge-standardized ratesGeneral surgery careState Inpatient DatabasesGeneral surgery operationsRandom-effects modelWide geographic variationHospital mortalityInpatient DatabaseSurgery careKruskal-Wallis testMortality rateUnwarranted variationMortalityStandardized ratesLinear random effects modelSurgery operationsUnited StatesGeographic variationCareBenchmarking the value of care: Variability in hospital costs for common operations and its association with procedure volume.
Zogg CK, Bernard AC, Hirji SA, Minei JP, Staudenmayer KL, Davis KA. Benchmarking the value of care: Variability in hospital costs for common operations and its association with procedure volume. Journal Of Trauma And Acute Care Surgery 2020, 88: 619-628. PMID: 32039972, PMCID: PMC7802807, DOI: 10.1097/ta.0000000000002611.Peer-Reviewed Original ResearchConceptsLaparoscopic appendectomyLaparoscopic cholecystectomyHospital costsMeans of USMedian costProcedure volumeEmergency general surgeryTotal hospital costsMedian hospital costsNational Inpatient SampleAdults 18 yearsNational cost savingsAnnual procedure volumeValue of careHospital complicationsIndex hospitalHealth care valuePatient characteristicsAdverse outcomesInpatient SampleInclusion criteriaGeneral surgeryHospitalLevel IIICommon operationHospital Variation in Geriatric Surgical Safety for Emergency Operation
Becher RD, Sukumar N, DeWane MP, Stolar MJ, Gill TM, Schuster KM, Maung AA, Zogg CK, Davis KA. Hospital Variation in Geriatric Surgical Safety for Emergency Operation. Journal Of The American College Of Surgeons 2020, 230: 966-973.e10. PMID: 32032720, PMCID: PMC7409563, DOI: 10.1016/j.jamcollsurg.2019.10.018.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioHospital-level characteristicsGeneral surgery operationsGeriatric patientsEmergency operationHospital variationEmergency general surgery operationsMean standardized mortality ratioCalifornia State Inpatient DatabaseHospital-based mortalitySignificant hospital variationPatients 65 yearsSubstantial excess mortalitySurgery operationsState Inpatient DatabasesMixed effects logistic regression modelsCommon general surgery operationsLow-mortality outliersLogistic regression modelsPostoperative mortalityHospital deathOlder patientsInpatient DatabaseMortality outcomesNonelective operations
2019
Hospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Becher RM, Maung AA, Schuster KM, Davis KA. Hospital Operative Volume and Quality Indication for General Surgery Operations Performed Emergently in Geriatric Patients. Journal Of The American College Of Surgeons 2019, 228: 910-923. PMID: 31005629, PMCID: PMC6582986, DOI: 10.1016/j.jamcollsurg.2019.02.053.Peer-Reviewed Original ResearchConceptsHospital operative volumeGeneral surgery operationsGeriatric patientsOperative volumeEmergency operationHospital volumeProbability of survivalEmergency general surgery operationsCalifornia State Inpatient DatabaseRetrospective cohort studySurgery operationsState Inpatient DatabasesHigher operative volumesAverage mortality riskOlder patientsCohort studyInpatient DatabaseGeriatric populationSurgical careSurgical qualityAmerican CollegeMortality riskOptimizing outcomesStandardized increasePatientsSymptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery
Sandler BJ, Davis KA, Schuster KM. Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 86: 479-488. PMID: 30531208, DOI: 10.1097/ta.0000000000002161.Peer-Reviewed Original ResearchConceptsHIV/AIDS patientsHIV-negative patientsAsymptomatic HIV-positive patientsHIV-positive patientsActive antiretroviral therapyAIDS patientsAntiretroviral therapyHospital stayPostoperative complicationsHuman immunodeficiency virus-infected patientsEmergency general surgery proceduresHigher median total chargesImmune deficiency syndrome (AIDS) patientsHuman immunodeficiency virus (HIV) infectionEmergency general surgeryLonger hospital stayRetrospective cohort studyAcute renal failureHIV-negative controlsImmunodeficiency virus infectionVirus-infected patientsRecords of patientsUrinary tract infectionMedian total chargesNationwide Inpatient Sample
2018
Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients
Zogg CK, Jiang W, Ottesen TD, Shafi S, Schuster K, Becher R, Davis KA, Haider AH. Racial/Ethnic Disparities in Longer-term Outcomes Among Emergency General Surgery Patients. Annals Of Surgery 2018, 268: 968-979. PMID: 28742704, PMCID: PMC5783796, DOI: 10.1097/sla.0000000000002449.Peer-Reviewed Original ResearchConceptsEmergency general surgery patientsNon-Hispanic whitesGeneral surgery patientsLong-term outcomesNon-Hispanic blacksNon-Hispanic AsiansMinority patientsMajor morbidityUnplanned readmissionSurgery patientsOlder adultsRisk-adjusted Cox proportional hazards modelsEthnic disparitiesCox proportional hazards modelDiagnostic categoriesRacial/Ethnic DisparitiesUS population agesProportional hazards modelNHB patientsNonagenarian patientsNHW patientsBACKGROUND DATAHospital's percentageMortality differencesMedicare dataTransfer status
DeWane MP, Davis KA, Schuster KM, Erwin SP, Maung AA, Becher RD. Transfer status. Journal Of Trauma And Acute Care Surgery 2018, 85: 348-353. PMID: 29664889, DOI: 10.1097/ta.0000000000001939.Peer-Reviewed Original ResearchConceptsOutside emergency departmentHospital inpatient unitsEmergency departmentNursing homesInpatient unitTransfer statusSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseBackward multivariable logistic regressionOutside hospital emergency departmentEmergency general surgery patientsQuality Improvement Program databaseMultivariate Cox regression analysisEmergency colon surgeryGeneral surgery patientsThirty-day mortalityImprovement Program databaseChronic care facilitiesCox regression analysisRates of morbidityTransfer of patientsHospital emergency departmentHospital inpatient wardsEmergent colectomyPhysiologic decompensationVenous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?
DeWane MP, Davis KA, Schuster KM, Maung AA, Becher RD. Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge? Journal Of The American College Of Surgeons 2018, 226: 1072-1077.e3. PMID: 29574180, DOI: 10.1016/j.jamcollsurg.2018.03.021.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualEmergenciesFemaleHumansMalePatient DischargePatient ReadmissionPostoperative ComplicationsRisk FactorsUnited StatesVenous ThromboembolismConceptsVenous thromboembolismEmergency general surgery operationsPost-discharge venous thromboembolismEmergency general surgery patientsMultivariable logistic regression modelingCommon EGS operationsGeneral surgery patientsRate of readmissionUrinary tract infectionSurgeons NSQIP databaseHigh-risk groupGeneral surgery operationsLogistic regression modelingEGS operationsProphylactic anticoagulationVTE formationVTE prophylaxisVTE ratesEGS patientsPostoperative sepsisNSQIP databaseProlonged lengthSurgery patientsTract infectionsPredictive factorsA simple predictor of post-operative complications after open surgical adhesiolysis for small bowel obstruction
Asuzu D, Pei KY, Davis KA. A simple predictor of post-operative complications after open surgical adhesiolysis for small bowel obstruction. The American Journal Of Surgery 2018, 216: 67-72. PMID: 29548529, DOI: 10.1016/j.amjsurg.2018.02.031.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedFemaleHumansIntestinal ObstructionIntestine, SmallLaparoscopyMaleMiddle AgedPostoperative ComplicationsPrognosisQuality ImprovementRetrospective StudiesTissue AdhesionsConceptsPost-operative complicationsSmall bowel obstructionBowel obstructionOpen lysisSurgical managementSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseAdhesive small bowel obstructionQuality Improvement Program databaseImprovement Program databaseAvailable clinical parametersPrior sepsisAnesthesiologists classificationClinical parametersSurgical adhesiolysisFunctional statusProgram databaseAmerican CollegeComplicationsObstructionLogistic regressionPreoperative modelCharacteristic curveAmerican SocietyFASComparison of Outcomes in Below-Knee Amputation between Vascular and General Surgeons
Pei KY, Zhang Y, Sarac T, Davis KA. Comparison of Outcomes in Below-Knee Amputation between Vascular and General Surgeons. Annals Of Vascular Surgery 2018, 50: 259-268. PMID: 29501591, DOI: 10.1016/j.avsg.2017.11.073.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmputation, SurgicalChi-Square DistributionClinical CompetenceDatabases, FactualEmergenciesFemaleGeneral SurgeryHospitals, TeachingHumansLength of StayLinear ModelsLogistic ModelsLower ExtremityMaleMiddle AgedMultivariate AnalysisOdds RatioPostoperative ComplicationsRetrospective StudiesRisk FactorsSpecializationSurgeonsTime FactorsTreatment OutcomeUnited StatesVascular Surgical ProceduresConceptsVascular surgeonsGeneral surgeonsKnee amputationInfectious indicationsNational Surgical Quality Improvement Project databaseSurgeons National Surgical Quality Improvement Project databaseUnconditional logistic regression modelsRisk of pneumoniaPeripheral vascular diseaseLower extremity amputationBelow knee amputationComparison of outcomesEffect of specialtyLogistic regression modelsOverall complicationsVascular consultationPostoperative complicationsPatient demographicsPostoperative outcomesPulmonary embolismComorbid conditionsRegression modelsExtremity amputationRetrospective studyVascular diseaseComparison of Internal Medicine and General Surgery Residents' Assessments of Risk of Postsurgical Complications in Surgically Complex Patients
Healy JM, Davis KA, Pei KY. Comparison of Internal Medicine and General Surgery Residents' Assessments of Risk of Postsurgical Complications in Surgically Complex Patients. JAMA Surgery 2018, 153: 203-207. PMID: 29049425, PMCID: PMC5885933, DOI: 10.1001/jamasurg.2017.3936.Peer-Reviewed Original ResearchMeSH KeywordsFemaleGeneral SurgeryHumansInternal MedicineInternship and ResidencyMalePatient SelectionPostoperative ComplicationsRisk AssessmentSelf EfficacySurgical Procedures, OperativeConceptsInternal medicine residentsComplex patientsGeneral surgery residentsPostsurgical complicationsMedicine residentsGeneral surgeryInternal medicineSurgery residentsSurgical site infectionSmall bowel resectionInguinal hernia repairInternal medicine serviceRisk-adjusted outcomesRisk-adjusted modelsDuodenal ulcer repairGeneral surgery practiceComplex clinical scenariosGeneral surgery traineesRisk of interventionCardiac complicationsComplex patient scenariosPostoperative complicationsSurgical complicationsSite infectionSurgical riskSurgeons overestimate postoperative complications and death when compared with the National Surgical Quality Improvement Project risk calculator
Pei KY, Healy J, Davis KA. Surgeons overestimate postoperative complications and death when compared with the National Surgical Quality Improvement Project risk calculator. Journal Of Surgical Research 2018, 225: 95-100. PMID: 29605041, DOI: 10.1016/j.jss.2018.01.008.Peer-Reviewed Original ResearchMeSH KeywordsForecastingHumansInternship and ResidencyMorbidityPostoperative ComplicationsQuality ImprovementRetrospective StudiesRisk AssessmentRisk FactorsSurgeonsSurgical Procedures, OperativeConceptsComplex surgical patientsGeneral surgery residentsSurgical patientsRisk calculatorNational Surgical Quality Improvement ProjectSurgical Quality Improvement ProjectSurgery residentsSurgical site infectionOverall response rateSurgical Risk CalculatorPrediction of morbidityQuality improvement projectRisk-adjusted modelsCardiac complicationsPostoperative complicationsPostoperative morbiditySite infectionSurgical riskComplex patientsAmerican CollegeClinical scenariosMorbidityResponse rateComplicationsPatientsRelationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction
Brandt WS, Wood J, Bhattacharya B, Pei K, Davis KA, Schuster K. Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction. Journal Of Surgical Research 2018, 225: 40-44. PMID: 29605033, DOI: 10.1016/j.jss.2017.12.031.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAscitesEquipment and Supplies UtilizationFemaleFood IntoleranceHumansIleusIntensive Care UnitsIntestinal ObstructionIntestine, SmallLength of StayMaleMiddle AgedParenteral NutritionPostoperative ComplicationsPreoperative PeriodRetrospective StudiesRisk FactorsTime FactorsTime-to-TreatmentYoung AdultConceptsTolerance of dietSmall bowel obstructionPreoperative symptomsLength of stayPostoperative ileusUnivariable analysisTotal durationIntensive care unit admissionTotal parenteral nutrition useParenteral nutrition useCare unit admissionIntensive care unitPreoperative ascitesBowel obstructionPrimary endpointSecondary endpointsSymptom durationUnit admissionMedian durationOperative interventionPostoperative outcomesCare unitMultivariable analysisRetrospective reviewNutrition useProphylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy
Merola J, Arnold B, Luks V, Ibarra C, Resio B, Davis KA, Pei KY. Prophylactic Ureteral Stent Placement vs No Ureteral Stent Placement During Open Colectomy. JAMA Surgery 2018, 153: 87-90. PMID: 28973647, PMCID: PMC5833617, DOI: 10.1001/jamasurg.2017.3477.Peer-Reviewed Original Research
2017
Impact of Race on the Surgical Management of Adhesive Small Bowel Obstruction
Chiu AS, Jean RA, Davis KA, Pei KY. Impact of Race on the Surgical Management of Adhesive Small Bowel Obstruction. Journal Of The American College Of Surgeons 2017, 226: 968-976.e1. PMID: 29170020, DOI: 10.1016/j.jamcollsurg.2017.11.006.Peer-Reviewed Original ResearchConceptsSmall bowel obstructionManagement of SBOAdhesive small bowel obstructionBowel obstructionWhite patientsOpen surgeryPatient raceNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramSurgical decision-making processSmall bowel resectionQuality Improvement ProgramLogistic regression modelsAnesthesiologists classPostoperative complicationsBowel resectionPatient comorbiditiesHospital admissionNonsurgical managementBlack patientsHispanic patientsSurgical managementOpen procedureProvider judgmentGeneral surgeonsLaparoscopic colectomy reduces complications and hospital length of stay in colon cancer patients with liver disease and ascites
Pei KY, Asuzu DT, Davis KA. Laparoscopic colectomy reduces complications and hospital length of stay in colon cancer patients with liver disease and ascites. Surgical Endoscopy 2017, 32: 1286-1292. PMID: 28812198, DOI: 10.1007/s00464-017-5806-4.Peer-Reviewed Original ResearchConceptsHospital lengthLaparoscopic colectomyColon cancerPostoperative complicationsOdds ratioNational Surgical Quality Improvement Program databaseSurgeons National Surgical Quality Improvement Program databaseQuality Improvement Program databaseOpen partial colectomyImprovement Program databaseShorter hospital lengthRisk of deathAdjusted odds ratioHigh-risk populationColon cancer patientsTwo-sample t-testConclusionsLaparoscopic colectomyOverall complicationsPerioperative complicationsPostoperative outcomesPostoperative riskAbsolute contraindicationLaparoscopic approachLiver diseaseOperative timeAssessing trends in laparoscopic colostomy reversal and evaluating outcomes when compared to open procedures
Pei KY, Davis KA, Zhang Y. Assessing trends in laparoscopic colostomy reversal and evaluating outcomes when compared to open procedures. Surgical Endoscopy 2017, 32: 695-701. PMID: 28726139, DOI: 10.1007/s00464-017-5725-4.Peer-Reviewed Original ResearchConceptsReversal surgeryLength of stayColostomy reversalComplication rateSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramUnconditional logistic regression modelsStudy periodTotal hospital lengthOverall complication rateProbability of morbidityShorter operation timeQuality Improvement ProgramLogistic regression modelsLaparoscopic colostomyLaparoscopic reversalMethodsAll patientsPostsurgical diagnosisHospital lengthPostoperative complicationsNSQIP databasePatient demographicsHartmann's reversalComorbid conditions
2016
Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation
Bhattacharya B, Maung A, Barre K, Maerz L, Rodriguez-Davalos MI, Schilsky M, Mulligan DC, Davis KA. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation. Journal Of Surgical Research 2016, 207: 223-228. PMID: 27979481, DOI: 10.1016/j.jss.2016.08.084.Peer-Reviewed Original ResearchConceptsLiver transplantationHospital lengthEnd-stage liver disease (MELD) scoreIntensive care unit LOSHigher preoperative modelImportant postoperative complicationLiver Disease scoreLiver transplant patientsImpact of deliriumTertiary care centerRetrospective case seriesUrinary tract infectionFurther prospective studiesIntensive care unitLong-term outcomesSpecific risk factorsFrequency of hospitalPaucity of dataPostoperative deliriumPostoperative hospitalPostoperative complicationsTransplant patientsVentilator daysAdult patientsDelirious patientsWill laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database
Pei KY, Asuzu D, Davis KA. Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database. Surgical Endoscopy 2016, 31: 2180-2186. PMID: 27585468, DOI: 10.1007/s00464-016-5216-z.Peer-Reviewed Original ResearchConceptsSmall bowel obstructionHospital stayAmerican CollegeNational Surgical Quality Improvement Program data setNational Surgical Quality Improvement Project databaseSurgeons National Surgical Quality Improvement Project databasePost-surgical complication rateLonger hospital stayLarge retrospective analysisLysis of adhesionsSignificant healthcare burdenMultivariable logistic regressionStandard of carePost-surgical complicationsProgram data setTwo-sample t-testMann-Whitney testLaparoscopic lysisOpen lysisLaparoscopic managementComplication rateClinical benefitLargest comparison studyHealthcare burdenSBO cases