Using Outcomes to Guide Treatment of Surgical Emergencies

紧急普通外科(EGS)情况由一组急性、非创伤性诊断定义，这些诊断需要 送到急诊科接受手术或非手术治疗。在……里面 是 全 这个 心 组成 总括 使用 合理的 自然界 审判 运行中 方法 的 次等 仅在美国，就有300-400万成年人 每年因EGS疾病住院和治疗，因此EGS疾病占7% 住院治疗。EGS的状况每年导致约800,000次手术，并花费≈280亿美元。 EGS对住院护理的负担比新诊断的糖尿病或癌症、冠心病更大 疾病、心力衰竭、中风或艾滋病毒。老年人，他们面临更大的不良后果风险， 超过一半的成年EGS人口。EGS状况的运营管理导致 并发症发生率为50%，再住院率为4%-18%，死亡率可接近15%， 年龄较大的患者表现出明显更高的风险。非手术管理被认为是一种 然而，另一项研究显示，结果喜忧参半。随机对照试验受到侵入性因素的限制 手术治疗的复杂性、病情的异质性以及EGS的急性性。此外，大多数 比较了不同类型的手术或非手术干预，比较的相对较少 治疗以非手术治疗为主。到目前为止，对EGS治疗结果的观察性研究 数量有限，并且容易受到选择偏差的影响。缺乏关于相对有效性的证据 手术和非手术治疗已被证明会导致不必要的治疗差异和 手术结果。 R F 此外，鉴于人们对发展区域化系统的兴趣日益浓厚 自医学研究所委员会关于#年急诊护理未来的报告以来，EGS患者的护理工作进展 对于美国卫生系统，需要关于EGS中医院绩效的知识。这 用以下具体目标解决文献中的这些差距：(1)确定医院层面的因素 与EGS的绩效排名相关联，以便为区域化战略提供信息；(2)评估 该提案旨在 在特定的EGS条件下手术和非手术治疗的疗效比较 评估 痴呆症和种族将在其他方面进行检查。使用 学习 EGS。 方法 考查 将要 有效性 和 EGS条件下手术治疗效果的异质性 来自联邦医疗保险受益人的SING数据，建议 是否会在#年首次在全国范围内进行手术和非手术治疗的比较效果分析 该方案采用：(1)模板匹配来定义EGS中的医院质量(2)工具变量 通过指示和(3)交互模型来克服通过指示来克服的最佳远近匹配 患者因素与治疗结果之间的条件关系。在这样做的过程中，发现 提供对最佳EGS结果所需的医院因素的洞察，并建立比较 EGS的操作条件，以通知进一步的调查和持续的做法。患者、提供者 医疗保险将受益于EGS中由此产生的高价值护理。 。年龄的条件影响， B类 C ，

Emergency general surgery (EGS) conditions are defined by a group of acute, non-trauma diagnoses that require presentation to an emergency department for operative or non-operative care. In are all The heart comprise overall with reasonable nature trials operative method of inferior the US alone, 3-4 million adults hospitalized and treated for an EGS condition each year such that EGS conditions are responsible for 7% of hospitalizations. EGS conditions result in an estimated 800,000 operations annually and cost ≈ $28 billion. burden of EGS on inpatient care is greater than that of a new diagnosis of diabetes or cancer, coronary disease, heart failure, stroke, or HIV. Older adults, who are at increased risk of adverse outcomes, more than half of the adult EGS population. Operative management of EGS conditions results in an complication ate of 50%, with a readmission rate of 4-18%, and a mortality rate that can approach 15%, older patients demonstrating a significantly higher risk. Non-operative management is considered a alternative yet studies show mixed results. Randomized control trials are limited by the invasive of operative treatment, the heterogeneity of conditions, and the acute nature of EGS. Furthermore, most have compared different types of operative or non-operative interventions, with relatively few comparing treatment to non-operative treatment. To date, observational studies o EGS outcomes by treatment are limited in number and subject to selection bias. A lack of evidence on the comparative effectiveness operative and non-operative treatment has been shown to result in unnecessary variations in treatment and operative outcomes. r f Furthermore, given the growing interest in the development of a regionalized system of care for EGS patients since the Institute of Medicine Committee report on the Future of Emergency Care in the United States Health System, knowledge on hospital performance in EGS is needed. This address these gaps in the literature with the following specific aims: (1) To identify hospital-level factors associated with rankings on performance in EGS to inform strategies on regionalization, (2) To evaluate the proposal aims to comparative effectiveness of operative and non-operative treatment in specific EGS conditions and (3) To evaluate dementia and race will be examined amongst others. U study EGS. approach examine will effectiveness and heterogeneity in the effectiveness of operative treatment in EGS conditions sing data from Medicare beneficiaries, the proposed will e the first nationwide comparative effectiveness analysis of operative and non-operative treatment in The proposal employs: (1) template matching to define hospital quality in EGS (2) an instrumental variable with optimal near-far matching to overcome onfounding by indication and, (3) interaction models to the conditional r elationship between treatment and outcomes by patient factors. In so doing the findings provide insights into hospital factors necessary for optimal EGS outcomes and establish the comparative of OP of EGS conditions to inform further investigations and ongoing practices. Patients, providers Medicare will benefit from the resultant high value care in EGS. . Conditional effects of age, b c ,