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 ResearchConceptsEmergency 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
2019
High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. High-performance acute care hospitals: Excelling across multiple emergency general surgery operations in the geriatric patient. Journal Of Trauma And Acute Care Surgery 2019, 87: 140-146. PMID: 31259872, PMCID: PMC7656193, DOI: 10.1097/ta.0000000000002273.Peer-Reviewed Original ResearchMeSH KeywordsAgedCaliforniaCluster AnalysisEmergenciesHospital MortalityHospitalsHumansSurgical Procedures, OperativeConceptsCommon EGS operationsEmergency general surgeryOlder patientsGeriatric patientsEmergency general surgery operationsEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsPatients 65 yearsRisk-adjusted mortalitySurvival rates 1State Inpatient DatabasesGeneral surgery operationsClusters of hospitalsOperation typeHospital performanceEGS patientsSurgery HospitalInpatient DatabaseGroup of hospitalsGeriatric populationGeneral surgeryPatientsHospitalLevel IIITop-tier emergency general surgery hospitals: Good at one operation, good at them all.
DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA, Becher RD. Top-tier emergency general surgery hospitals: Good at one operation, good at them all. Journal Of Trauma And Acute Care Surgery 2019, 87: 289-296. PMID: 31349347, PMCID: PMC6771423, DOI: 10.1097/ta.0000000000002367.Peer-Reviewed Original ResearchConceptsRisk-adjusted mortalityEGS hospitalsHospital risk-adjusted mortalityOperation typeEGS operationsCalifornia State Inpatient DatabaseGeneral surgery hospitalsHospital-level factorsAcute care hospitalsState Inpatient DatabasesAmerican Hospital Association databasePoor-performing hospitalsSystems of careLow-risk operationAssessment of mortalityAdult patientsCare hospitalSurgery HospitalInpatient DatabaseHospital characteristicsMultinomial logistic regressionMortality rateHospitalLevel IIIZ-scoreThe current and future economic state of acute care surgery.
Staudenmayer K, Bernard A, Davis KA, Doucet J, Haider A, Tres Scherer LR, Minei JP. The current and future economic state of acute care surgery. Journal Of Trauma And Acute Care Surgery 2019, 87: 413-419. PMID: 31033894, DOI: 10.1097/ta.0000000000002334.Peer-Reviewed Original ResearchHospital 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 increasePatientsEvaluating mortality outlier hospitals to improve the quality of care in emergency general surgery.
Becher RD, DeWane MP, Sukumar N, Stolar MJ, Gill TM, Maung AA, Schuster KM, Davis KA. Evaluating mortality outlier hospitals to improve the quality of care in emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 87: 297-306. PMID: 30908450, PMCID: PMC6660354, DOI: 10.1097/ta.0000000000002271.Peer-Reviewed Original ResearchConceptsStandardized mortality ratioOutlier hospitalsHospital variationMortality ratioStandardized mortalityEmergency general surgery operationsCalifornia State Inpatient DatabaseEGS operationsCommon EGS operationsSignificant hospital variationEmergency general surgeryHospital-level characteristicsHospital-level variablesSignificant excess mortalityGeneral surgery operationsState Inpatient DatabasesQuality improvement initiativesQuality of careHospital quality indicatorsNational Quality ForumEGS outcomesInpatient DatabaseExcess mortalityOnly hospitalEpidemiologic studiesSymptomatic 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 decompensationValidation of a new American Association for the Surgery of Trauma (AAST) anatomic severity grading system for acute cholecystitis
Vera K, Pei KY, Schuster KM, Davis KA. Validation of a new American Association for the Surgery of Trauma (AAST) anatomic severity grading system for acute cholecystitis. Journal Of Trauma And Acute Care Surgery 2018, 84: 650-654. PMID: 29271871, DOI: 10.1097/ta.0000000000001762.Peer-Reviewed Original ResearchConceptsLength of stayAcute cholecystitisICU useGrade 2Anatomic gradingAdverse eventsGrade 1Longer LOSAnatomic grading systemGrade 1 diseaseEmergency general surgeryGrade 3 patientsRetrospective cohort studyIncidence of complicationsMajority of patientsTertiary medical centerLow-grade diseaseSurgery of TraumaRisk-adjusted outcomesGood inter-rater reliabilityAAST gradeAmerican AssociationCholecystitis severityCohort studyConsecutive patientsVenous 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 ResearchConceptsVenous 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 factorsComparison 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 disease
2017
Ongoing Evolution of Emergency General Surgery as a Surgical Subspecialty
Becher RD, Davis KA, Rotondo MF, Coimbra R. Ongoing Evolution of Emergency General Surgery as a Surgical Subspecialty. Journal Of The American College Of Surgeons 2017, 226: 194-200. PMID: 29111417, DOI: 10.1016/j.jamcollsurg.2017.10.014.Commentaries, Editorials and Letters
2013
When the ICU is the operating room
Piper GL, Maerz LL, Schuster KM, Maung AA, Luckianow GM, Davis KA, Kaplan LJ. When the ICU is the operating room. Journal Of Trauma And Acute Care Surgery 2013, 74: 871-875. PMID: 23425750, DOI: 10.1097/ta.0b013e31827e9c52.Peer-Reviewed Original ResearchConceptsSurgical intensive care unitOperating roomOperative locationICU casesEmergency general surgery patientsGeneral surgery patientsTotal operative casesType of anesthesiaIntensive care unitMode of ventilationT-testStudent's t-testSurgery patientsCare unitNeuromuscular blockadeAdverse outcomesDeep sedationProcedure typeOperative procedureSurgical proceduresEpidemiologic studiesICU databaseCase volumeLevel ITotal cases
2011
Can Acute Care Surgeons Perform Emergency Colorectal Procedures With Good Outcomes?
Schuster KM, McGillicuddy EA, Maung AA, Kaplan LJ, Davis KA. Can Acute Care Surgeons Perform Emergency Colorectal Procedures With Good Outcomes? Journal Of Trauma And Acute Care Surgery 2011, 71: 94-101. PMID: 21818018, DOI: 10.1097/ta.0b013e31821e43d2.Peer-Reviewed Original ResearchConceptsAcute care surgeonsEmergency colorectal proceduresColorectal proceduresColorectal emergenciesPatient characteristicsExact testIntensive care unit lengthElective colorectal casesOpen abdominal techniquePerioperative risk factorsExtended care facilitiesLength of stayFisher's exact testLow case volumeChi-square testLogistic regression modelsACS mortalityAnesthesiology classColorectal casesPreoperative hypotensionColorectal operationsElective resectionVentilator daysElderly patientsSignificant comorbidities