2020
Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons
Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE, Becher RD. Functional Effects of Intervening Illnesses and Injuries After Hospitalization for Major Surgery in Community-living Older Persons. Annals Of Surgery 2020, 273: 834-841. PMID: 33074902, PMCID: PMC8370041, DOI: 10.1097/sla.0000000000004438.Peer-Reviewed Original ResearchConceptsMajor surgeryED visitsRestricted activityFunctional statusFunctional declineOlder personsCommunity-living older personsAdjusted hazard ratioAdverse functional outcomesCommunity-living personsEmergency department visitsTraditional risk factorsCorresponding odds ratiosFunctional effectsIllness/injuryHazard ratioDepartment visitsFunctional recoveryFunctional outcomeRisk factorsOdds ratioHospitalizationSurgeryInjuryVisitsGeographic 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 variationCare
2019
Regionalization of emergency general surgery operations: A simulation study.
Becher RD, Sukumar N, DeWane MP, Gill TM, Maung AA, Schuster KM, Stolar MJ, Davis KA. Regionalization of emergency general surgery operations: A simulation study. Journal Of Trauma And Acute Care Surgery 2019, 88: 366-371. PMID: 31804419, PMCID: PMC7472889, DOI: 10.1097/ta.0000000000002543.Peer-Reviewed Original ResearchConceptsEmergency general surgeryHigh-volume hospitalsEGS careEmergency general surgery operationsCalifornia inpatient databaseCommon EGS operationsRisk-adjusted deathsSignificant survival benefitLow-volume hospitalsUmbilical hernia repairSmall bowel resectionHigh-mortality hospitalsGeneral surgery operationsRegional trauma systemEGS operationsBowel resectionAdult patientsPrimary outcomeSurvival benefitInpatient DatabaseHernia repairTrauma systemLevel IVGeneral surgeryCare managementHigh-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-scoreHospital 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 ResearchMeSH KeywordsCaliforniaEmergenciesFemaleHospital MortalityHospitalsHumansMaleMiddle AgedQuality ImprovementQuality Indicators, Health CareSurgical Procedures, OperativeConceptsStandardized 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 studiesFactors Associated With Functional Recovery Among Older Survivors of Major Surgery
Becher RD, Murphy TE, Gahbauer EA, Leo-Summers L, Stabenau HF, Gill TM. Factors Associated With Functional Recovery Among Older Survivors of Major Surgery. Annals Of Surgery 2019, Publish Ahead of Print: &na;. PMID: 30741734, PMCID: PMC6684864, DOI: 10.1097/sla.0000000000003233.Peer-Reviewed Original ResearchConceptsFunctional recoveryMajor surgeryOlder personsElective surgeryYears of educationPersons 70 yearsProspective longitudinal studyGreater increaseHospital dischargeSurgical treatmentGeriatric patientsMedian timePresurgical levelsOlder survivorsHigh riskSurgeryMost older personsPremorbid functionPotential predictorsAnalytic sampleMonthsDisabilityLongitudinal studyImpairmentCurrent study
2018
Functional Trajectories Before and After Major Surgery in Older Adults
Stabenau HF, Becher RD, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional Trajectories Before and After Major Surgery in Older Adults. Annals Of Surgery 2018, 268: 911-917. PMID: 29356710, PMCID: PMC6521949, DOI: 10.1097/sla.0000000000002659.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAged, 80 and overDisability EvaluationFemaleGeriatric AssessmentHumansLongitudinal StudiesMalePrognosisProspective StudiesRecovery of FunctionSurgical Procedures, OperativeConceptsMajor surgeryNonelective surgeryFunctional trajectoriesSevere disabilityOlder adultsCourse of disabilityFirst major surgeryPersons 70 yearsProspective cohort studyCohort studyFunctional prognosisModerate disabilityPartial improvementSurgeryPremorbid functionOlder personsStudy periodAnalytic sampleLittle improvementRapid improvementTrajectory groupsMild disabilityMost participantsDisabilityGradual improvement
2011
Creation and Implementation of an Emergency General Surgery Registry Modeled after the National Trauma Data Bank
Becher RD, Meredith JW, Chang MC, Hoth JJ, Beard HR, Miller PR. Creation and Implementation of an Emergency General Surgery Registry Modeled after the National Trauma Data Bank. Journal Of The American College Of Surgeons 2011, 214: 156-163. PMID: 22153352, DOI: 10.1016/j.jamcollsurg.2011.11.001.Peer-Reviewed Original ResearchConceptsNational Trauma Data BankTrauma Data BankEGS patientsInclusion criteriaEGS serviceICD-9 diagnostic codesICD-9 diagnosis codesEGS patient outcomesAcute care surgeryICD-9 codesEGS admissionsCare surgeryRetrospective reviewProspective populationDiagnosis codesProspective dataDiagnostic codesPatient outcomesPatientsSurgery evolvesPatient identificationMulti-institutional collaborationAdmissionMonthsOutcomesA Critical Assessment of Outcomes in Emergency versus Nonemergency General Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Database
Becher RD, Hoth JJ, Miller PR, Mowery NT, Chang MC, Meredith JW. A Critical Assessment of Outcomes in Emergency versus Nonemergency General Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Database. The American Surgeon 2011, 77: 951-959. PMID: 21944366, DOI: 10.1177/000313481107700738.Peer-Reviewed Original ResearchMeSH KeywordsAgedDatabases, FactualEmergency TreatmentFemaleHumansMalePostoperative ComplicationsSurgical Procedures, OperativeTreatment OutcomeUnited StatesConceptsEmergent operationPostoperative morbidityAmerican CollegeNonemergent casesSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseGeneral surgery inpatientsGeneral surgery patientsImprovement Program databaseDeep vein thrombosisSpecific outcome dataGeneral surgery operationsGeneral surgery proceduresHigh mortality rateSystems of carePostoperative complicationsRenal failureSurgery patientsVein thrombosisNonemergent patientsHigh morbidityPoor outcomeUnique ClinicalInflammatory response