For a study, the researchers sought to find how much variance there was in the rates of emergency general surgery (EGS) procedures and subsequent death in the Northeastern and Southeastern United States (US) to establish geographic variation in general emergency surgery (EGS) care. The State Inpatient Databases (2011–2012) for 6 states representing the Northeastern (New York) and Southeastern (Florida, Georgia, Kentucky, North Carolina, Mississippi) US were used to identify patients under the age of 18 who undergone 1 of 10 common EGS surgeries. The hospital service area (HSA) served as the geographic unit of study. Investigators estimated and plotted age-standardized rates of operations and in-hospital mortality. The Kruskal–Wallis test was used to examine rate differences across geographic locations, and linear random-effects models were used to quantify variation. To compare geographically heterogeneous areas, variation profiles were tabulated using normalized use and death rates. Across the 6 states, 227,109 EGS operations were geospatially evaluated. Region (Northeast rate of 22.7 EGS procedures per 10,000 in the population against Southeast rate of 21.9; P<0.001), state (ranging from 9.9 to 29.1; P<0.001), and HSA (1.9–56.7; P<0.001) all had substantial differences in age-standardized EGS operation rates. At the region level (Northeast mortality rate 7.2 per 1,000 operations versus Southeast 7.4; P<0.001), state-level (varying from 5.9 to 9.0 fatalities per 1,000 EGS operations; P<0.001), and HSA level (0.0–77.3; P<0.001), the regional diversity in age-standardized EGS mortality rates was likewise significant. Visually, maps and variation profiles revealed extensive and significant disparities in EGS use and morality. The frequencies of EGS surgeries and consequent death vary dramatically among 6 Northeastern and Southeastern US states. More extensive geographic investigations were needed to figure out what was causing these differences and how to reduce them.
