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Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care

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Harvard

Achanta, A, Nordestgaard, A, Kongkaewpaisan, N, Han, K, Mendoza, A, Saillant, N, Rosenthal, M, Fagenholz, P, Velmahos, G & Kaafarani, HMA 2019, 'Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care', The journal of trauma and acute care surgery, bind 87, nr. 2, s. 408-412. https://doi.org/10.1097/TA.0000000000002279

APA

Achanta, A., Nordestgaard, A., Kongkaewpaisan, N., Han, K., Mendoza, A., Saillant, N., Rosenthal, M., Fagenholz, P., Velmahos, G., & Kaafarani, H. M. A. (2019). Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care. The journal of trauma and acute care surgery, 87(2), 408-412. https://doi.org/10.1097/TA.0000000000002279

CBE

MLA

Vancouver

Author

Achanta, Aditya ; Nordestgaard, Ask ; Kongkaewpaisan, Napaporn ; Han, Kelsey ; Mendoza, April ; Saillant, Noelle ; Rosenthal, Martin ; Fagenholz, Peter ; Velmahos, George ; Kaafarani, Haytham M A. / Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care. I: The journal of trauma and acute care surgery. 2019 ; Bind 87, Nr. 2. s. 408-412.

Bibtex

@article{29820065b960418b90a1b51081593506,
title = "Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care",
abstract = "Hospital length of stay (LOS) is currently recognized as a key quality indicator. We sought to investigate how much of the LOS variation in the high-risk group of patients undergoing Emergency general surgery could be explained by clinical versus nonclinical factors. METHODS Using the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we included all patients who underwent an emergency appendectomy, cholecystectomy, colectomy, small intestine resection, enterolysis, or hernia repair. American College of Surgeons National Surgical Quality Improvement Program defines emergency surgery as one that is performed no later than 12 hours after admission or symptom onset. Using all the ACS-NSQIP demographic, preoperative (comorbidities, laboratory variables), intraoperative (e.g., duration of surgery, wound classification), and postoperative variables (i.e., complications), we created multivariable linear regression models to predict LOS. LOS was treated as a continuous variable, and the degree to which the models could explain the variation in LOS for each type of surgery was measured using the coefficient of determination (R 2). RESULTS A total of 215,724 patients were included. The mean age was 47.1 years; 52.0% were female. In summary, the median LOS ranged between 1 day for appendectomies (n = 124, 426) and cholecystectomies (n = 21,699) and 8 days for colectomies (n = 19,557) and small intestine resections (n = 7,782). The R 2 for all clinical factors ranged between 0.28 for cholecystectomy and 0.44 for hernia repair, suggesting that 56% to 72% of the LOS variation for each of the six procedures studied cannot be explained by the wide range of clinical factors included in ACS-NSQIP. CONCLUSION Most of the LOS variation is not explained by clinical factors and may be explained by nonclinical factors (e.g., logistical delays, insurance type). Further studies should evaluate these nonclinical factors to identify target areas for quality improvement. LEVELS OF EVIDENCE Epidemiological study, level III. ",
keywords = "ACS-NSQIP, clinical variation, emergency general surgery, Length of stay",
author = "Aditya Achanta and Ask Nordestgaard and Napaporn Kongkaewpaisan and Kelsey Han and April Mendoza and Noelle Saillant and Martin Rosenthal and Peter Fagenholz and George Velmahos and Kaafarani, {Haytham M A}",
year = "2019",
month = aug,
doi = "10.1097/TA.0000000000002279",
language = "English",
volume = "87",
pages = "408--412",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams & Wilkins",
number = "2",

}

RIS

TY - JOUR

T1 - Most of the variation in length of stay in emergency general surgery is not related to clinical factors of patient care

AU - Achanta, Aditya

AU - Nordestgaard, Ask

AU - Kongkaewpaisan, Napaporn

AU - Han, Kelsey

AU - Mendoza, April

AU - Saillant, Noelle

AU - Rosenthal, Martin

AU - Fagenholz, Peter

AU - Velmahos, George

AU - Kaafarani, Haytham M A

PY - 2019/8

Y1 - 2019/8

N2 - Hospital length of stay (LOS) is currently recognized as a key quality indicator. We sought to investigate how much of the LOS variation in the high-risk group of patients undergoing Emergency general surgery could be explained by clinical versus nonclinical factors. METHODS Using the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we included all patients who underwent an emergency appendectomy, cholecystectomy, colectomy, small intestine resection, enterolysis, or hernia repair. American College of Surgeons National Surgical Quality Improvement Program defines emergency surgery as one that is performed no later than 12 hours after admission or symptom onset. Using all the ACS-NSQIP demographic, preoperative (comorbidities, laboratory variables), intraoperative (e.g., duration of surgery, wound classification), and postoperative variables (i.e., complications), we created multivariable linear regression models to predict LOS. LOS was treated as a continuous variable, and the degree to which the models could explain the variation in LOS for each type of surgery was measured using the coefficient of determination (R 2). RESULTS A total of 215,724 patients were included. The mean age was 47.1 years; 52.0% were female. In summary, the median LOS ranged between 1 day for appendectomies (n = 124, 426) and cholecystectomies (n = 21,699) and 8 days for colectomies (n = 19,557) and small intestine resections (n = 7,782). The R 2 for all clinical factors ranged between 0.28 for cholecystectomy and 0.44 for hernia repair, suggesting that 56% to 72% of the LOS variation for each of the six procedures studied cannot be explained by the wide range of clinical factors included in ACS-NSQIP. CONCLUSION Most of the LOS variation is not explained by clinical factors and may be explained by nonclinical factors (e.g., logistical delays, insurance type). Further studies should evaluate these nonclinical factors to identify target areas for quality improvement. LEVELS OF EVIDENCE Epidemiological study, level III.

AB - Hospital length of stay (LOS) is currently recognized as a key quality indicator. We sought to investigate how much of the LOS variation in the high-risk group of patients undergoing Emergency general surgery could be explained by clinical versus nonclinical factors. METHODS Using the 2007 to 2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we included all patients who underwent an emergency appendectomy, cholecystectomy, colectomy, small intestine resection, enterolysis, or hernia repair. American College of Surgeons National Surgical Quality Improvement Program defines emergency surgery as one that is performed no later than 12 hours after admission or symptom onset. Using all the ACS-NSQIP demographic, preoperative (comorbidities, laboratory variables), intraoperative (e.g., duration of surgery, wound classification), and postoperative variables (i.e., complications), we created multivariable linear regression models to predict LOS. LOS was treated as a continuous variable, and the degree to which the models could explain the variation in LOS for each type of surgery was measured using the coefficient of determination (R 2). RESULTS A total of 215,724 patients were included. The mean age was 47.1 years; 52.0% were female. In summary, the median LOS ranged between 1 day for appendectomies (n = 124, 426) and cholecystectomies (n = 21,699) and 8 days for colectomies (n = 19,557) and small intestine resections (n = 7,782). The R 2 for all clinical factors ranged between 0.28 for cholecystectomy and 0.44 for hernia repair, suggesting that 56% to 72% of the LOS variation for each of the six procedures studied cannot be explained by the wide range of clinical factors included in ACS-NSQIP. CONCLUSION Most of the LOS variation is not explained by clinical factors and may be explained by nonclinical factors (e.g., logistical delays, insurance type). Further studies should evaluate these nonclinical factors to identify target areas for quality improvement. LEVELS OF EVIDENCE Epidemiological study, level III.

KW - ACS-NSQIP

KW - clinical variation

KW - emergency general surgery

KW - Length of stay

UR - http://www.scopus.com/inward/record.url?scp=85070661173&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002279

DO - 10.1097/TA.0000000000002279

M3 - Journal article

C2 - 30958809

VL - 87

SP - 408

EP - 412

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -

ID: 57805994