{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:48:12Z","timestamp":1791802092605,"version":"4.3.4"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:p>Nearly 1\u00a0million older adults are hospitalized annually for emergency general surgery (EGS) conditions in the United States. Recent literature has demonstrated the impact of discordant care in EGS, defined as a mismatch between treatment choice and patients\u2019 clinical risk profile. In the present work, we characterize the association between preoperative decision variation and outcomes in elderly EGS patients.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All geriatric (\u226565\u00a0years) hospitalizations with EGS conditions (appendicitis, diverticulitis, cholecystitis, hernia, bowel obstruction, perforated peptic ulcer, intestinal ischemia, perforated bowel) were tabulated from the 2022 National Inpatient Sample (NIS). A propensity score (PS) was developed to estimate the likelihood of undergoing operative management. Low and high probability for surgery was defined using a cut-off of PS = 0.5. Model-concordant cases were defined as those whose treatment matched their predicted likelihood, while model-discordant cases did not. Multivariable regression models were developed to determine the association of care variation on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of an estimated 900\u2009730 patients with EGS conditions, 154\u2009300 (17.1%) were classified as model-discordant. Following risk adjustment, model-discordance was associated with greater odds of mortality (AOR: 1.33, 95% CI: 1.25-1.42), as well as gastrointestinal (AOR: 2.07, 95% CI: 1.95-2.19), infectious (AOR: 1.41, 95% CI: 1.36-1.46), and respiratory (AOR: 1.26, 95% CI: 1.20-1.32) complications. Furthermore, model-discordance was associated with increased hospitalization costs (\u03b2: +$9\u2009760, 95% CI: +$9\u2009255-10\u2009265) and length of stay duration (\u03b2: +2.72\u00a0days, 95% CI: +2.59-2.84).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients classified as model-discordant exhibited elevated rates of in-hospital mortality and postoperative complications. Given this variation, our study warrants investigation into guideline adherence and outcomes in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261443565","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T13:41:37Z","timestamp":1776346897000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Operative Decision Discordance in Geriatric Emergency General Surgery"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6513-6907","authenticated-orcid":false,"given":"Owen","family":"Lai","sequence":"first","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konmal","family":"Ali","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3087-4573","authenticated-orcid":false,"given":"Jaden","family":"Rahmani","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deep","family":"Mehta","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Shaheer","family":"Ali","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areti","family":"Tillou","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yas","family":"Sanaiha","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"},{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4705-0262","authenticated-orcid":false,"given":"Peyman","family":"Benharash","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at UCLA"},{"name":"David Geffen School of Medicine at UCLA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.0811"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000003346"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.02.013"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.5397"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.06.013"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2025.6155"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2023-001288"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000005519"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.11.025"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0b013e31819432e5"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26735"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.10234"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.20502"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1590\/0102-672020230031e1749"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.05.018"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000005172"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1404068"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2022.11.058"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000002224"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-023-00506-7"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2018.01.008"}],"container-title":["The 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