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State-by-state variation in emergency versus elective colon resections: Room for improvement

Obirieze, Augustine C. MBBS, MPH; Kisat, Mehreen MBBS; Hicks, Caitlin W. MD, MS; Oyetunji, Tolulope A. MD, MPH; Schneider, Eric B. PhD; Gaskin, Darrell J. PhD; Haut, Elliott R. MD; Efron, David T. MD; Cornwell, Edward E. III MD; Haider, Adil H. MD, MPH

Journal of Trauma and Acute Care Surgery: May 2013 - Volume 74 - Issue 5 - p 1286–1291
Original Articles

BACKGROUND: Compared with elective surgical procedures, emergency procedures are associated with higher cost, morbidity, and mortality. This study seeks to investigate potential state-by-state variations in the incidence of emergent versus elective colon resections.

METHODS: A retrospective analysis of all adult patients (aged >=18 years) included in the Nationwide Inpatient Sample from 2005 to 2009 who underwent hemicolectomy (right or left) or sigmoidectomy was conducted. Discharge-level weights were applied, and generalized linear models were used to assess the odds of a patient undergoing emergent versus elective colon surgery nationally and for each state after adjusting for patient and hospital factors. Odds ratios (ORs) were estimated with the national average as the reference.

RESULTS: The final study cohort included 203,050 observations composed of 83,090 emergent and 119,960 elective colectomies. The state with the highest unadjusted proportion of emergent procedures was Nevada (53.6%), whereas Texas had the lowest (2.8%). Compared with the national average, the adjusted odds of undergoing emergency colectomy remained highest in Nevada (OR, 1.70; 95% confidence interval, 1.54–1.87) and lowest in Texas (OR, 0.43; 95% confidence interval, 0.36–0.51).

CONCLUSION: Substantial state variations exist in rates of emergency colon surgery within the United States. Identification of these differences suggests significant variations in practice and a potential to decrease the number of emergent colon operations.

LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.

From the Outcomes Research Center, Department of Surgery, Howard University College of Medicine, Washington, District of Columbia (A.C.O., T.A.O., E.E.C.); and Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine (M.K., C.W.H., E.B.S., E.R.H., D.T.E., A.H.H.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (D.J.G.).

Submitted: September 27, 2012, Revised: December 14, 2012, Accepted: December 18, 2012.

This study was presented at the 7th Annual Academic Surgical Congress of Association for Academic Surgery, February 14–16, 2012, in Las Vegas, Nevada.

Address for reprints: Adil H. Haider, MD, MPH, Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, 600 N Wolfe St, Halsted 610, Baltimore, MD 21212; email:

© 2013 Lippincott Williams & Wilkins, Inc.