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Background: Emergency general surgery is associated with high morbidity and mortality but has seldom been targeted for practice improvement. The goal of this study was to determine whether perioperative practices vary among surgeons for emergency Hartmann's procedures and whether perioperative care practices are associated with hospitals' complication rates., Materials and Methods: We conducted a survey of surgeons at 27 Michigan hospitals. Questionnaires focused on preoperative, intraoperative, and postoperative care practices. Hospitals were divided into quartiles of risk-adjusted complication rates. Responses of surgeons at hospitals with the lowest complication rates were compared to those with the highest, to determine whether there were systematic differences. Qualitative content analysis was performed for open-ended questions., Results: A total of 106 surgeons returned questionnaires (response rate 49%). We identified variation in use of bowel preparation, ostomy site marking, rectal stump management, ostomy protrusion, skin closure method, antibiotics duration, and ambulation/physical therapy practices. Surgeons from hospitals with low complication rates were more likely to use a clean instrument tray during wound closure (61% versus 11%, P = 0.001) and reported greater use of laparoscopic lavage without resection for emergency diverticulitis cases (31% versus 6%, P = 0.05). Surgeons in the lower complication rate hospitals listed more modifiable care factors in their open-ended responses to questions about reasons for complications., Conclusions: Surgeons' practices vary for emergency Hartmann's procedure. This study serves as a proof of concept that studying surgeons' practices is feasible within a quality collaborative setting. Such data can be used to generate testable hypotheses for performance improvement aimed in high-risk, emergency surgery., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The practice of ambulatory surgery has expanded greatly as a result of advances in surgical technology and rising financial pressures. We sought to characterize the utilization of ambulatory surgical practices for common general surgical procedures in Michigan., Materials and Methods: We identified 33,655 patients within the Michigan Surgery Quality Collaborative clinical registry undergoing general surgical procedures performed on an ambulatory basis between 25% and 75% of the time. Our primary outcome was the incidence of ambulatory surgery. Using multilevel mixed-effects logistic regression models, we adjusted ambulatory surgery utilization rates for patient comorbidities, procedure composition, and hospital characteristics. We then assessed the incidence of postoperative complications across hospitals grouped by their ambulatory surgery utilization rates., Results: Adjusted utilization rates of ambulatory surgery varied widely across 34 hospitals from 29%-75% (mean = 54%). Risk-adjusted complication rates for ambulatory cases were similar between hospitals performing the least (2.2%) and the most ambulatory surgery (2.3%, P = 0.365). Patient factors and hospital characteristics accounted for 23.3% of the between-hospital variability in ambulatory surgery utilization, whereas most variation was explained by effects at the surgeon level., Conclusions: Despite wide variation in ambulatory surgery utilization for general surgical procedures, we were unable to explain observed differences by patient comorbidities, case mix, or hospital characteristics. These data suggest that understanding factors associated with ambulatory surgery utilization may represent a novel avenue for quality improvement within our statewide surgical collaborative., (Copyright © 2014 Elsevier Inc. All rights reserved.)