Multicenter validation of American association for the surgery of trauma grading system for acute XXXX and its use for emergency general surgery quality improvement program.

@entity1 @entity204 @entity12127 @entity130
INTRODUCTION: The American Association for the Surgery of @entity130 (AAST) has developed a new grading system for uniform description of anatomic severity of Emergency General Surgery (EGS) diseases, ranging from Grade I (mild) to Grade V (severe). The purpose of this study was to determine the relationship of AAST grades for acute @entity12127 with @entity1 outcomes. A secondary purpose was to propose an EGS Quality Improvement Program (EQIP) using risk-adjusted center outcomes, similar to NSQIP and TQIP methodology. METHODS: This was a retrospective study of 1105 @entity1 (one @entity204 ) from 13 centers. At each center, 2 reviewers (blinded to each other's assignments) assigned AAST grades. Inter-rater reliability was measured using kappa coefficient. Relationship between AAST grade and clinical events (complications, intensive care unit use, surgical intervention, and 30-day readmission), as well as length of stay, was measured using regression analyses to control for age, comorbidities, and physiologic status at the time of admission. Final model was also used to calculate observed-to-expected (O-E) ratios for adverse outcomes ( @entity204 , complications, readmissions) for each center. RESULTS: Median age was 54 years, 52% were males, 43% were minorities, and 22% required a surgical intervention. Almost two-thirds had Grade I or II disease. There was high level of agreement for grades between reviewers (kappa 0.81). Regression analysis showed that higher disease grades were independently associated with all clinical events and length of stay, after adjusting for age, comorbidities, and physiology. O-E ratios showed one center with significantly lower-than-expected risk of @entity204 , complications, and readmissions. CONCLUSIONS: AAST grades for acute @entity12127 are independently associated with clinical outcomes and resource use. EQIP methodology that incorporates AAST grade, age, comorbidities, and physiologic status may be used for measuring quality of EGS care. High-quality EGS registries are essential for developing meaningful quality metrics. LEVEL OF EVIDENCE: Level V - Retrospective Study STUDY TYPE: Retrospective multicenter study.
