# Using Outcomes to Guide Treatment of Surgical Emergencies

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $89,893

## Abstract

Emergency general surgery (EGS) conditions are defined by a group of acute, non-trauma diagnoses that require
presentation to an emergency department for operative or non-operative care. In
are
all
The
heart
comprise
overall
with
reasonable
nature
trials
operative
method
of
inferior
the US alone, 3-4 million adults
hospitalized and treated for an EGS condition each year such that EGS conditions are responsible for 7% of
hospitalizations. EGS conditions result in an estimated 800,000 operations annually and cost ≈ $28 billion.
burden of EGS on inpatient care is greater than that of a new diagnosis of diabetes or cancer, coronary
 disease, heart failure, stroke, or HIV. Older adults, who are at increased risk of adverse outcomes,
more than half of the adult EGS population. Operative management of EGS conditions results in an
complication ate of 50%, with a readmission rate of 4-18%, and a mortality rate that can approach 15%,
 older patients demonstrating a significantly higher risk. Non-operative management is considered a
 alternative yet studies show mixed results. Randomized control trials are limited by the invasive
of operative treatment, the heterogeneity of conditions, and the acute nature of EGS. Furthermore, most
have compared different types of operative or non-operative interventions, with relatively few comparing
treatment to non-operative treatment. To date, observational studies o EGS outcomes by treatment
are limited in number and subject to selection bias. A lack of evidence on the comparative effectiveness
operative and non-operative treatment has been shown to result in unnecessary variations in treatment and
operative outcomes.
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f
Furthermore, given the growing interest in the development of a regionalized system
of care for EGS patients since the Institute of Medicine Committee report on the Future of Emergency Care in
the United States Health System, knowledge on hospital performance in EGS is needed. This
address these gaps in the literature with the following specific aims: (1) To identify hospital-level factors
associated with rankings on performance in EGS to inform strategies on regionalization, (2) To evaluate the
proposal aims to
comparative effectiveness of operative and non-operative treatment in specific EGS conditions and (3) To
evaluate
dementia and race will be examined amongst others. U
study
EGS.
approach
examine
will
effectiveness
and
heterogeneity in the effectiveness of operative treatment in EGS conditions
sing data from Medicare beneficiaries, the proposed
will e the first nationwide comparative effectiveness analysis of operative and non-operative treatment in
The proposal employs: (1) template matching to define hospital quality in EGS (2) an instrumental variable
 with optimal near-far matching to overcome onfounding by indication and, (3) interaction models to
the conditional r elationship between treatment and outcomes by patient factors. In so doing the findings
 provide insights into hospital factor...

## Key facts

- **NIH application ID:** 10370161
- **Project number:** 3R01AG060612-03S1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Rachel Kelz
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $89,893
- **Award type:** 3
- **Project period:** 2019-05-15 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10370161

## Citation

> US National Institutes of Health, RePORTER application 10370161, Using Outcomes to Guide Treatment of Surgical Emergencies (3R01AG060612-03S1). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10370161. Licensed CC0.

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