{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T15:34:14Z","timestamp":1783697654217,"version":"3.55.0"},"reference-count":37,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR002547"],"award-info":[{"award-number":["KL2TR002547"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,5,15]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The decision to undertake a surgical intervention for an emergency general surgery (EGS) condition (appendicitis, diverticulitis, cholecystitis, hernia, peptic ulcer, bowel obstruction, ischemic bowel) involves a complex consideration of factors, particularly in older adults. We hypothesized that identifying variability in the application of operative management could highlight a potential pathway to improve patient survival and outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We included adults aged 65+ years with\u2009an EGS condition from the 2016\u20132017 National Inpatient Sample. Operative management was determined from procedure codes. Each patient was assigned a propensity score (PS) for the likelihood of undergoing an operation, modeled from patient and hospital factors: EGS diagnosis, age, gender, race, presence of shock, comorbidities, and hospital EGS volumes. Low and high probability for surgery was defined using a PS cut-off of 0.5. We identified two model-concordant groups (no surgery-low probability, surgery-high probability) and two model-discordant groups (no surgery-high probability, surgery-low probability). Logistic regression estimated the adjusted OR (AOR) of in-hospital mortality for each group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 375\u2009546 admissions, 21.2% underwent surgery. Model-discordant care occurred in 14.6%; 5.9% had no surgery despite a high PS and 8.7% received surgery with low PS. In the adjusted regression, model-discordant care was associated with significantly increased mortality: no surgery-high probability AOR 2.06 (1.86 to 2.27), surgery-low probability AOR 1.57 (1.49 to 1.65). Model-concordant care showed a protective effect against mortality (AOR 0.83, 0.74 to 0.92).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Nearly one in seven EGS patients received model-discordant care, which was associated with higher mortality. Our study suggests that streamlined treatment protocols can be applied in EGS patients as a means to save lives.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>III.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2023-001288","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T02:40:27Z","timestamp":1719369627000},"page":"e001288","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Mortality burden from variation in provision of surgical care in emergency general surgery: a cohort study using the National Inpatient Sample"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-2555","authenticated-orcid":false,"given":"Vanessa P","family":"Ho","sequence":"first","affiliation":[{"name":"Surgery, The MetroHealth System, Cleveland, Ohio, USA"},{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA"},{"name":"Population Health and Equity Research Institute, The MetroHealth System, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"Towe","sequence":"additional","affiliation":[{"name":"Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wyatt P","family":"Bensken","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Pfoh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarrod","family":"Dalton","sequence":"additional","affiliation":[{"name":"Center for Populations Health Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred F","family":"Connors","sequence":"additional","affiliation":[{"name":"The MetroHealth System, Cleveland, Ohio, USA"},{"name":"Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3526-2241","authenticated-orcid":false,"given":"Jeffrey A","family":"Claridge","sequence":"additional","affiliation":[{"name":"Surgery, The MetroHealth System, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam T","family":"Perzynski","sequence":"additional","affiliation":[{"name":"Population Health and Equity Research Institute, The MetroHealth System, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"2025082410213261000_9.1.e001288.1","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2016.1689","article-title":"Association of loss of independence with readmission and death after discharge in older patients after surgical procedures","volume":"151","author":"Berian","year":"2016","journal-title":"JAMA Surg"},{"key":"2025082410213261000_9.1.e001288.2","article-title":"Increased mortality in the elderly after emergency abdominal surgery","volume":"61","author":"Svenningsen","year":"2014","journal-title":"Dan Med J"},{"key":"2025082410213261000_9.1.e001288.3","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1308\/rcsann.2017.0203","article-title":"Outcomes of surgery in patients aged >\/=90 years in the general surgical setting","volume":"100","author":"Sudlow","year":"2018","journal-title":"Ann R Coll Surg 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Safety of cholecystectomy in superelderly patients (>\/= age 90)","volume":"21","author":"Irojah","year":"2017","journal-title":"Perm J"},{"key":"2025082410213261000_9.1.e001288.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07805-z"},{"key":"2025082410213261000_9.1.e001288.9","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005519"},{"key":"2025082410213261000_9.1.e001288.10","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jamcollsurg.2019.09.017","article-title":"Enhancing the American college of surgeons NSQIP surgical risk calculator to predict geriatric outcomes","volume":"230","author":"Hornor","year":"2020","journal-title":"J Am Coll Surg"},{"key":"2025082410213261000_9.1.e001288.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.07.385"},{"key":"2025082410213261000_9.1.e001288.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.330.7505.1401"},{"key":"2025082410213261000_9.1.e001288.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61216-7"},{"key":"2025082410213261000_9.1.e001288.14","doi-asserted-by":"crossref","first-page":"100849","DOI":"10.1016\/j.cpsurg.2020.100849","article-title":"The impact of trauma systems on patient outcomes","volume":"58","author":"Choi","year":"2021","journal-title":"Curr Probl Surg"},{"key":"2025082410213261000_9.1.e001288.15","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2021-000744","article-title":"Improving length of stay on a trauma service","volume":"6","author":"Biffl","year":"2021","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025082410213261000_9.1.e001288.16","unstructured":"HCUP National Inpatient Sample (NIS) . 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