Emergency general surgery outcomes at safety net hospitals

Charles Patrick Shahan, Teresa Bell, Elena Paulus, Ben L. Zarzaur

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background The United States hospital safety net is defined by the Agency for Healthcare Research and Quality as the top decile of hospitals, which see the greatest proportion of uninsured patients. These hospitals provide important access to health care for uninsured patients but are commonly believed to have worse outcomes. The aim of this study was to compare the outcomes of emergency general surgery procedures performed at safety net and nonsafety net hospitals. Material and methods The Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2008-2010 was used to create a cohort of inpatients who underwent emergency appendectomy, cholecystectomy, or herniorrhaphy. Outcomes measured included length of stay, charge, cost, death in hospital, complications, and failure to rescue (FTR). Univariate and logistic regression analysis was performed to associate variables with outcomes. Results A total of 187,913 emergency general surgery cases were identified, 11.5% of which were performed at safety net hospitals. The safety net cohort had increased length of stay but lower mean charge and cost. Age, comorbidity score, black race, male gender, and Medicaid and Medicare insurance were associated with mortality, complication, and FTR. Lower socioeconomic status was associated with mortality and complication. Safety net status was positively associated with complication but not mortality or FTR. Conclusions Safety net hospitals had higher complication rates but no difference in FTR or mortality. This may mean that the hospitals are able to effectively recognize and treat patient complications and do so without increased cost.

Original languageEnglish (US)
Pages (from-to)113-117
Number of pages5
JournalJournal of Surgical Research
Issue number1
StatePublished - Jun 1 2015
Externally publishedYes


  • Emergency general surgery
  • Health care policy
  • Safety net

ASJC Scopus subject areas

  • Surgery


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