Quick Cuts: Surgeon Tendency to Operate in Emergency General Surgery.

INTRODUCTION

Individual surgeons have different practice patterns. The extent of variation across surgeons in the use of operative and nonoperative treatment remains unknown. This study examines differences in the use of operative treatment for emergency general surgery (EGS) conditions at the surgeon level.

METHODS

Patients aged ≥18 y hospitalized for EGS conditions were identified in the Healthcare Cost and Utilization Project State Inpatient Database (2016-2020) in FL/MD/NV using International Classification of Diseases, Tenth Revision codes. Tendency to operate (TTO = number of operations performed/number of patients treated) was calculated at the surgeon level for all EGS conditions and for complicated diverticulitis and cholecystitis. Differences in surgeon practice and patient attributes by the lowest and highest surgeon TTO quartiles were examined.

RESULTS

Overall, 1884 surgeons treated 347,589 patients with EGS conditions. Median surgeon TTO was 59% [interquartile interval: 44%, 68%] for all EGS conditions. Median surgeon TTO was 44% [25%, 59%] for complicated diverticulitis and 74% [66%, 81%] for cholecystitis. Low-TTO surgeons treated fewer EGS patients per year than high-TTO surgeons (median 23 versus 41, P < 0.001). Of note, the total number of inpatients (EGS and non-EGS) treated per surgeon per year was similar between low- and high-TTO surgeons (103 versus 104 patients, P < 0.001).

CONCLUSIONS

The use of operative treatment for common EGS conditions depends, in part, on the surgeon that each patient is randomly assigned. Moreover, many EGS conditions are managed nonoperatively by surgeons. Surgeons should be compensated for the totality of their expertise.