title: The importance of improving the quality of emergency surgery for a regional quality collaborative.
abstract: BACKGROUND
  Within a large, statewide collaborative, significant improvement in surgical quality has been appreciated (9.0% reduction in morbidity for elective general and vascular surgery). Our group has not noted such quality improvement in the care of patients who had emergency operations. With this work, we aim to describe the scope of emergency surgical care within the Michigan Surgical Quality Collaborative, variations in outcomes among hospitals, and variations in adherence to evidence-based process measures. Overall, these data will form a basis for a broad-based quality improvement initiative within Michigan.
  
  
  METHODS
  We report morbidity, mortality, and costs of emergency and elective general and vascular surgery cases (N = 190,826) within 34 hospitals participating in the Michigan Surgical Quality Collaborative from 2005 to 2010. Adjusted hospital-specific outcomes were calculated using a stepwise multivariable logistic regression model. Adjustment covariates included patient specific comorbidities and case complexity. Hospitals were also compared on the basis of their adherence to evidence-based process measures [measures at the patient level for each case-Surgical Care Improvement Project (SCIP)-1 and SCIP-2 compliance].
  
  
  RESULTS
  Emergency procedures account for approximately 11% of total cases, yet they represented 47% of mortalities and 28% of surgical complications. The complication-specific cost to payers was $126 million for emergency cases and $329 million for elective cases. Adjusted patient outcomes varied widely within Michigan Surgical Quality Collaborative hospitals; morbidity and mortality rates ranged from 16.3% to 33.9% and 4.0% to 12.4%, respectively. The variation among hospitals was not correlated with volume of emergency cases and case complexity. Hospital performance in emergency surgery was found to not depend on its share of emergent cases but rather was found to directly correlate with its performance in elective surgery. For emergency colectomies, there was a wide variation in compliance with SCIP-1 and SCIP-2 measures and overall compliance (42.0%) was markedly lower than that for elective colon surgery (81.7%).
  
  
  CONCLUSIONS
  Emergency surgical procedures are an important target for future quality improvement efforts within Michigan. Future work will identify best practices within high-performing hospitals and disseminate these practices within the collaborative.
authors.affiliation: Michigan Young Surgery Investigator Training and Enrichment Program, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Smith
authors.forename: Adnan
authors.initials: A
authors.lastname: Hussain
authors.forename: Jane
authors.initials: J
authors.lastname: Xiao
authors.forename: William
authors.initials: W
authors.lastname: Scheidler
authors.forename: Haritha
authors.initials: H
authors.lastname: Reddy
authors.forename: Kola
authors.initials: K
authors.lastname: Olugbade
authors.forename: Dustin
authors.initials: D
authors.lastname: Cummings
authors.forename: Michael
authors.initials: M
authors.lastname: Terjimanian
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
authors.forename: Darrell
authors.initials: D
authors.lastname: Campbell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D017046:Cost Savings; D004638:Emergency Treatment / Q000191:economics / Q000592:standards*; D055416:Evidence-Based Emergency Medicine / Q000592:standards; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008824:Michigan; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012041:Regional Medical Programs; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000592:standards*; D016896:Treatment Outcome