Angela M. Ingraham, MD, Mark E. Cohen, PhD, Mehul V

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Variation in Quality of Care after Emergency General Surgery Procedures in the Elderly Angela M. Ingraham, MD, Mark E. Cohen, PhD, Mehul V. Raval, MD, Clifford Y. Ko, MD, MS, MSHS, FACS, Avery B. Nathens, MD, MPH, PhD, FACS Journal of the American College of Surgeons Volume 212, Issue 6, Pages 1039-1048 (June 2011) DOI: 10.1016/j.jamcollsurg.2011.03.001 Copyright © 2011 American College of Surgeons Terms and Conditions

Fig. 1 Observed to expected (O/E) ratios and outlier status for serious morbidity and mortality following emergency general surgery procedures in the elderly and younger patients at American College of Surgery National Surgical Quality Improvement Program hospitals (2005 to 2008). Elderly patients were defined as those ≥65 years; young patients were those <65 years. Probabilities of the outcome of interest were determined for each age strata from logistic regression models. The probabilities were then summed for each hospital to estimate the hospitals' risk-adjusted serious morbidity or mortality. For each hospital, the observed number of events (O) was divided by the risk-adjusted expected number events (E) to produce an O/E ratio. An O/E ratio of 1.0 indicates that the number of observed events equales the number of expected events. O/E ratios less than 1.0 indicate better than expected outcomes; ratios greater than 1.0 indicate worse than expected outcomes. If the 95% CI of the O/E ratio for serious morbidity or the 90% CI for mortality did not include 1.0, then the risk-adjusted outcome was deemed statistically significant, and the hospital was designated as an “outlier.” Only hospitals that submitted a minimum of 20 emergency general surgery procedures in elderly patients during the study period were assigned an O/E ratio. The high and low outlier legend on this figure refers to the color rendition. Outlier status, however, is partially redundant with location; low outliers tend toward the left portion of the plots and high outliers tend toward the right. Journal of the American College of Surgeons 2011 212, 1039-1048DOI: (10.1016/j.jamcollsurg.2011.03.001) Copyright © 2011 American College of Surgeons Terms and Conditions

Figure 2 Correlation of observed to expected (O/E) ratios for (A) serious morbidity and (B) mortality after emergency general surgery procedures in the elderly compared with those in the young. Journal of the American College of Surgeons 2011 212, 1039-1048DOI: (10.1016/j.jamcollsurg.2011.03.001) Copyright © 2011 American College of Surgeons Terms and Conditions