Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative.

BACKGROUND: Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements. METHODS: We collected data at 10 hospitals from July 2019 to December 2022. Five cohorts were defined: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes investigated included operative versus nonoperative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. Multivariable risk adjustment accounted for variations in demographic, comorbid, anatomic, and disease traits. RESULTS: Of the 19,956 emergency general surgery patients, 56.8% were female and 82.8% were White, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5% (95% confidence interval [CI], 3.2-3.7), morbidity rate was 27.6% (95% CI, 27.0-28.3), and the readmission rate was 15.1% (95% CI, 14.6-15.6). Operative management varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Significant differences in outcomes between hospitals were observed with high- and low-outlier performers identified after risk adjustment in the overall cohort for mortality, morbidity, and readmissions. The use of a Gastrografin challenge in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. In patients who underwent initial nonoperative management of acute cholecystitis, 51.5% had a cholecystostomy tube placed. The cholecystostomy tube placement rate ranged from 23.5% to 62.1% across hospitals. CONCLUSION: A multihospital emergency general surgery collaborative reveals high morbidity with substantial variability in processes and outcomes among hospitals. A targeted collaborative quality improvement effort can identify outliers in emergency general surgery care and may provide a mechanism to optimize outcomes. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

USMLE Step 1 scores and PGY-5 ABSITE performance are predictive of American Board of Surgery examination first-time pass rates.

INTRO: Standardized exams are utilized throughout a resident's career. With USMLE Step 1 score reports changing to pass/fail only, we sought to evaluate the relationships among USMLE Step 1 and 2, PGY-5 ABSITE, and ABS performance. METHODS: Retrospective analyses of PGY-5 USMLE Step 1 and Step 2 scores, ABSITE percentile ranks, and ABS QE and CE first-time pass rates of graduates from 2010 to 2019 were performed. RESULTS: PGY-5 residents scoring ≤ 20th percentile on ABSITE during their PGY-5 year were more likely to have lower USMLE Step 1 scores, but not Step 2 scores, and have a lower ABS first pass rate. Lower Step and ABSITE scores together were associated with lower ABS first pass rate. CONCLUSION: As USMLE Step 1 is now a pass/fail examination, programs may need to utilize other information to select residency candidates and structure educational activities differently within their programs.

United States medical licensing examination Step 1 scores are a quantifiably better predictor of American Board of Surgery In-Training Examination success compared to Step 2 scores.

BACKGROUND: United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are used in the selection of surgery residents. The American Board of Surgery In-Training Examination (ABSITE) is employed to assess resident knowledge. We sought to determine whether both STEP 1 and/or STEP 2 were predictive of ABSITE performance. METHODS: We performed a 10-year retrospective analysis of all PGY levels comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank. Additionally, we analyzed STEP 1 and 2 scores for the likelihood of scoring above the 20th percentile on the ABSITE. RESULTS: When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE performance. However, when STEP 1 and STEP 2 scores were evaluated together, only STEP 1 scores were predictive of ABSITE performance. Finally, only STEP 1 scores were predictive of scoring above the 20th percentile. CONCLUSION: STEP 1 scores are a better predictor of ABSITE performance than STEP 2.