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Regional Variation in Rates of Pediatric Perforated Appendicitis
Vol. 223, No. 4S1, October 2016
Scientific Forum Abstracts
Table. Continued
FTR rate Medium High Very high
Model 1: hospital factors only,* OR (95% CI) 1.56 (1.26, 1.89) 1.98 (1.57, 2.46)
Model 2: surgeon and hospital factors* OR (95% CI) 1.30 (1.04, 1.75) 1.50 (1.18, 1.91)
2.96 (2.35, 3.64)
1.62 (1.30, 2.05)
*Both models also control for patient age, sex, comorbidities, primary diagnosis (neoplasm, diverticular disease, or inflammatory bowel disease), a minimally invasive approach, procedure type (colectomy, anterior resection, or abdominoperineal resection), additional organ resection, major complication, and hospital colorectal resection volume, academic status, and location (urban or rural). Model 2 also controls for surgeon colorectal resection volume, colorectal surgery board certification, and years in practice.
CONCLUSIONS: These data suggest that the association between FTR and postoperative mortality after colorectal surgery may be driven more strongly by surgeons than hospital factors. FTR should be considered as a quality metric for not only hospitals but also for surgeons.
Regional Variation in Rates of Pediatric Perforated Appendicitis Samir Sarda, Heather L Short, MD, Jason M Hockenberry, PhD, Ian McCarthy, PhD, Mehul V Raval, MD Emory University School of Medicine, Atlanta, GA INTRODUCTION: The Agency for Healthcare Research and Quality (AHRQ) designates perforated appendicitis admission rates as a prevention quality indicator (PQI) to be monitored by hospitals. Although trends in perforated appendicitis rates have been studied, regional variability in children requiring admission for perforated appendicitis remains unknown. METHODS: A retrospective, cross-sectional analysis of the 20062012 AHRQ Kid’s Inpatient Database was conducted to examine variation in perforated appendicitis admission rates by region of the US and insurance status. Rates of perforated appendicitis were calculated and reported as per 1,000 admissions in accordance with AHRQ specifications. RESULTS: National perforated appendicitis rates per 1,000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively (Table). The odds of perforated appendicitis were higher among the uninsured (odds ratio [OR] 1.11, [1.07-1.16]) compared with the insured (OR 0.94, [0.910.97]). The South had the largest proportion of uninsured and publicly insured visits, and the largest proportion of perforated appendicitis visits among the uninsured (6.2%). The South experienced a 14.3% decrease in perforated appendicitis rates from 2006 to 2009 followed by an 8.3% increase from 2009 to 2012. All other regions of the country displayed similar trends during these time periods. Although the Midwest ranked second lowest on this PQI in 2006, their rates were the highest in both 2009 and 2012, reaching 363.7 per 1,000 admissions. The
S117
Northeast has consistently experienced the lowest perforated appendicitis rates. Table. Perforated Appendicitis Rates per 1,000 Pediatric Admissions
Region
2006
Year 2009
2012
Northeast Midwest South West Total
255.5 316.2 326.3 335.8 313.9
237.3 294.6 279.6 294.4 279.2
254.5 363.7 302.9 316.9 309.1
CONCLUSIONS: Understanding regional variation in perforated appendicitis rates among children will inform health policymakers as initiatives within the Affordable Care Act, such as Medicaid expansion, evolve.
Retirement and the General Surgeon: A Practice Survey of Intentions and Perceptions Heather M Poushay, MD, Daniel J Kagedan, MD, Julie Hallet, MD, Kaitlyn Beyfuss, Ashlie Nadler, MD, Najma A Ahmed, MD, FACS, Frances C Wright, MD University of Toronto, Toronto, ON INTRODUCTION: Physician workforce planning is increasingly challenging. Little is known about retirement in surgery. We sought to evaluate intentions and perceptions of general surgeons (GS) regarding retirement. METHODS: We conducted a self-administered, paper-based survey of licensed GS in Ontario, Canada. We developed the questionnaire using a systematic approach of items generation and reduction. We tested face and content validity and reliability. We conducted a sensitivity analysis restricted to respondents <65 years old. RESULTS: Response rate was 33.5% (242/723). Characteristics of potential and actual respondents did not differ substantially. Seventy-five percent of respondents intended to stop operating as primary surgeon by age 67.5 (median, 65), and from all clinical work by age 72.5 (median, 70). Career satisfaction (97%), sense of identity (90%), and finances (69%) influenced the decision to stop operating, and work enjoyment (79%), camaraderie (66%), and finances (44%) influenced the decision to continue clinical work after stopping operating (Table). On multivariate analysis, younger respondents (36-50 years of age) were less likely to intend to operate beyond age 65 years (odds ratio [OR] 0.13), and academic surgeons were more likely to do so (OR 2.39). Younger age and female sex (OR 0.41) were independently associated with lower likelihood to intend to stop all clinical activity beyond age 70 years. Call coverage by nonstaff surgeons was not associated with retirement intentions. Sensitivity analysis did not substantially alter these results.
Scientific Forum Abstracts
Table. Continued
FTR rate Medium High Very high
Model 1: hospital factors only,* OR (95% CI) 1.56 (1.26, 1.89) 1.98 (1.57, 2.46)
Model 2: surgeon and hospital factors* OR (95% CI) 1.30 (1.04, 1.75) 1.50 (1.18, 1.91)
2.96 (2.35, 3.64)
1.62 (1.30, 2.05)
*Both models also control for patient age, sex, comorbidities, primary diagnosis (neoplasm, diverticular disease, or inflammatory bowel disease), a minimally invasive approach, procedure type (colectomy, anterior resection, or abdominoperineal resection), additional organ resection, major complication, and hospital colorectal resection volume, academic status, and location (urban or rural). Model 2 also controls for surgeon colorectal resection volume, colorectal surgery board certification, and years in practice.
CONCLUSIONS: These data suggest that the association between FTR and postoperative mortality after colorectal surgery may be driven more strongly by surgeons than hospital factors. FTR should be considered as a quality metric for not only hospitals but also for surgeons.
Regional Variation in Rates of Pediatric Perforated Appendicitis Samir Sarda, Heather L Short, MD, Jason M Hockenberry, PhD, Ian McCarthy, PhD, Mehul V Raval, MD Emory University School of Medicine, Atlanta, GA INTRODUCTION: The Agency for Healthcare Research and Quality (AHRQ) designates perforated appendicitis admission rates as a prevention quality indicator (PQI) to be monitored by hospitals. Although trends in perforated appendicitis rates have been studied, regional variability in children requiring admission for perforated appendicitis remains unknown. METHODS: A retrospective, cross-sectional analysis of the 20062012 AHRQ Kid’s Inpatient Database was conducted to examine variation in perforated appendicitis admission rates by region of the US and insurance status. Rates of perforated appendicitis were calculated and reported as per 1,000 admissions in accordance with AHRQ specifications. RESULTS: National perforated appendicitis rates per 1,000 admissions for 2006, 2009, and 2012 were 313.9, 279.2, and 309.1, respectively (Table). The odds of perforated appendicitis were higher among the uninsured (odds ratio [OR] 1.11, [1.07-1.16]) compared with the insured (OR 0.94, [0.910.97]). The South had the largest proportion of uninsured and publicly insured visits, and the largest proportion of perforated appendicitis visits among the uninsured (6.2%). The South experienced a 14.3% decrease in perforated appendicitis rates from 2006 to 2009 followed by an 8.3% increase from 2009 to 2012. All other regions of the country displayed similar trends during these time periods. Although the Midwest ranked second lowest on this PQI in 2006, their rates were the highest in both 2009 and 2012, reaching 363.7 per 1,000 admissions. The
S117
Northeast has consistently experienced the lowest perforated appendicitis rates. Table. Perforated Appendicitis Rates per 1,000 Pediatric Admissions
Region
2006
Year 2009
2012
Northeast Midwest South West Total
255.5 316.2 326.3 335.8 313.9
237.3 294.6 279.6 294.4 279.2
254.5 363.7 302.9 316.9 309.1
CONCLUSIONS: Understanding regional variation in perforated appendicitis rates among children will inform health policymakers as initiatives within the Affordable Care Act, such as Medicaid expansion, evolve.
Retirement and the General Surgeon: A Practice Survey of Intentions and Perceptions Heather M Poushay, MD, Daniel J Kagedan, MD, Julie Hallet, MD, Kaitlyn Beyfuss, Ashlie Nadler, MD, Najma A Ahmed, MD, FACS, Frances C Wright, MD University of Toronto, Toronto, ON INTRODUCTION: Physician workforce planning is increasingly challenging. Little is known about retirement in surgery. We sought to evaluate intentions and perceptions of general surgeons (GS) regarding retirement. METHODS: We conducted a self-administered, paper-based survey of licensed GS in Ontario, Canada. We developed the questionnaire using a systematic approach of items generation and reduction. We tested face and content validity and reliability. We conducted a sensitivity analysis restricted to respondents <65 years old. RESULTS: Response rate was 33.5% (242/723). Characteristics of potential and actual respondents did not differ substantially. Seventy-five percent of respondents intended to stop operating as primary surgeon by age 67.5 (median, 65), and from all clinical work by age 72.5 (median, 70). Career satisfaction (97%), sense of identity (90%), and finances (69%) influenced the decision to stop operating, and work enjoyment (79%), camaraderie (66%), and finances (44%) influenced the decision to continue clinical work after stopping operating (Table). On multivariate analysis, younger respondents (36-50 years of age) were less likely to intend to operate beyond age 65 years (odds ratio [OR] 0.13), and academic surgeons were more likely to do so (OR 2.39). Younger age and female sex (OR 0.41) were independently associated with lower likelihood to intend to stop all clinical activity beyond age 70 years. Call coverage by nonstaff surgeons was not associated with retirement intentions. Sensitivity analysis did not substantially alter these results.