Journal of the American College of Surgeons study outlines first-of-its-kind registry to address lack of information about factors influencing patient outcomes in acute care surgery
Researchers at Wake Forest Baptist Medical Center in Winston-Salem, NC, have successfully created and implemented an emergency general surgery registry (EGSR) that will advance the science of acute surgical care by allowing surgeons to track and improve surgical patient outcomes, create performance metrics, conduct valid research and ensure quality care for all emergency general surgery (EGS) patients. The registry, featured in a study published in the February 2012 issue of the Journal of the American College of Surgeons, was modeled after the American College of Surgeons (ACS) National Trauma Data Bank (NTDB) and components of the ACS National Surgical Quality Improvement Program (ACS NSQIP-). It is the first registry of its kind to establish ICD-9 codes (International Classification of Diseases) that help to define and evaluate EGS patients.
Today, trauma surgery is well documented and researched, and registries around the world like the NTDB further study traumatic injury and treatments. However, there are few published studies outlining the determinants of EGS outcomes and overall, there is poor understanding about the systems through which EGS care is delivered. EGS cases include a breadth of pathology including appendectomy, hernia repair, intestinal repair, abscess drainage, and cholecystectomy (removal of the gallbladder) - and these emergency procedures commonly represent extremely challenging cases. Many institutions currently evaluate EGS cases using discharge records that contain administrative data only and are not designed to track disease-specific variables.
"We consider the EGSR to be fundamental to our practice and hope it will become a national model to track and improve acute surgical care in the U.S.," said lead author of the study Preston R. Miller, MD, FACS, associate professor, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC. "This registry is a work-in-progress and as we move forward, it is critical that this be a coordinated, multi-institutional effort evaluating a myriad of acute surgical services with the goal to advance care and outcomes for EGS patients."
These patients fall into a broad profile spectrum - urgent or emergent, scheduled or elective, primary or secondary diagnoses, not always general surgery, and so on. Therefore, defining them is very challenging.