{"doi":"10.1016/j.jamcollsurg.2019.10.018","title":"Hospital Variation in Geriatric Surgical Safety for Emergency Operation","abstract":"BACKGROUND: The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortality vary in hospitals performing nonelective operations in geriatric patients? Second, can the differences in hospital-based mortality be explained by patient-, operative-, and hospital-level characteristics among outlier institutions? STUDY DESIGN: Patients 65 years and older who underwent 1 of 8 common emergency general surgery operations were identified using the California State Inpatient Database (2010 to 2011). Expected mortality was obtained from hierarchical, Bayesian mixed-effects logistic regression models. A risk-adjusted hospital-level standardized mortality ratio (SMR) was calculated from observed-to-expected in-hospital deaths. \"Outlier\" hospitals had an SMR 80% CI that did not cross the mean SMR of 1.0. High-mortality (SMR >1.0) and low-mortality (SMR <1.0) outliers were compared. RESULTS: We included 24,207 patients from 107 hospitals. SMRs varied widely, from 2.3 (highest) to 0.3 (lowest). Eleven hospitals (10.3%) were poor-performing high-SMR outliers, and 10 hospitals (9.3%) were exceptional-performing low-SMR outliers. SMR was 3 times worse in the high-SMR compared with the low-SMR group (1.7 vs 0.6; p < 0.001). Patient-, operation-, and hospital-level characteristics were equivalent among outlier-hospitals. CONCLUSIONS: Significant hospital variation exists in standardized mortality after common general surgery operations done emergently in older patients. More than 10% of institutions have substantial excess mortality. These findings confirm that the safety of emergency operation in geriatric patients can be significantly improved by decreasing the wide variability in mortality outcomes.","journal":"Journal of the American College of Surgeons","year":2020,"id":88789,"datarank":0.3453877639491069,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.0,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9549,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":449588,"name":"Nitin Sukumar","orcid":"0000-0002-7868-2254","position":1,"is_corresponding":false},{"id":449589,"name":"Michael P. DeWane","orcid":"0000-0002-7042-7400","position":2,"is_corresponding":false},{"id":450527,"name":"Marilyn Stolar","orcid":null,"position":3,"is_corresponding":false},{"id":242022,"name":"Thomas M. Gill","orcid":"0000-0002-6450-0368","position":4,"is_corresponding":false},{"id":449590,"name":"Kevin M. Schuster","orcid":"0000-0003-3773-8124","position":5,"is_corresponding":false},{"id":449591,"name":"Adrian A. Maung","orcid":"0000-0003-3853-5425","position":6,"is_corresponding":false},{"id":449592,"name":"Cheryl K. Zogg","orcid":"0000-0003-4461-746X","position":7,"is_corresponding":false},{"id":449593,"name":"Kimberly A. Davis","orcid":"0000-0001-5660-5293","position":8,"is_corresponding":false},{"id":403084,"name":"Robert D. Becher","orcid":"0000-0002-3717-865X","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T22:01:22.387926Z","pmid":"32032720","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}