• Patient Assessment Committee

    The AAST Patient Assessment Committee has had a very busy and successful year. Our committee has been tasked with developing systems to measure disease severity and patient outcomes for research and quality improvement in acute care surgery. This past year, we have continued to forward the state of knowledge for emergency general surgery, and are beginning to tackle other aspects of patient assessment tools.

     

    One of our largest projects in the past four years has been to define the scope and burden of emergency general surgery (EGS) diseases in the United States and to create an anatomic grading scale for EGS diseases that is intuitive and can be used for both clinical and research purposes. Anatomic severity of illness scales have been described for sixteen of the most common EGS inflammatory conditions, and these scales are now available on the AAST website for member use. Several of these grading scales have been externally validated and at least two more validation studies are currently ongoing. In addition, Dr. Stephanie Savage, from our committee, is heading a multicenter validation study of the AAST necrotizing soft tissue infection score. Finally, anatomic severity scores have been created for bleeding disorders. This data was recently presented at the Academic Surgical Congress, and will be submitted for publication in the next month.

     

    A second major project has been our partnership with the American College of Surgeons NSQIP EGS pilot project. This is a multicentered pilot to determine the feasibility and reproducibility of an EGS NSQIP evaluation tool. Preliminary data was presented last year at the AAST Annual Meeting; data collection is ongoing, and a manuscript, with preliminary results, has been submitted for publication.

     

    Third, we have been working to align coding and billing aspects of EGS with better patient assessment tools. A subcommittee, headed by Dr. Garth Utter, has been working on ICD-9/10 revisions of emergency general surgery diseases. Garth has attended in-person meetings and has participated in conference calls with the NCHS Coordination and Maintenance Committee. Despite a partial freeze on ICD revisions, four of our eleven proposals were adopted in October 2016 (mediastinitis, vascular insufficiency of the intestine, pancreatitis, and breast abscesses) and three more will likely be adopted in this fiscal year (cholecystitis, appendicitis, and surgical site infections). Two more are still under consideration (hernia and colitis). These changes allow for more surgically appropriate billing and coding, and the documentation now more easily aligns with our anatomic grading for risk stratification and research.

     

    Another important project has been the development of an EGS Optimal Resources Document, which would be similar to the trauma optimal resources document. This group is headed by former PAC Chair and ex-officio member, Dr. Shahid Shafi. I am providing editorial and writing support, and several other committee members are participating, along with other AAST members.

     

    Finally, the committee continues to work on interesting and impactful projects. We are currently working with the Geri-TRAC group and have plans for producing evidence-based reviews, op-eds, and educational materials. We are also finalizing a review of physiologic and other grading scales for risk stratification of EGS patients, and we anticipate that we’ll have a manuscript ready for submission by the end of March.

     

    In summary, I would like to thank all the hard-working members of the Patient Assessment Committee, the Board of Managers, Ms. Sharon Gautschy, and Ms. Brea Sanders for their invaluable support. Thank you for the opportunity to highlight our work!

     

    Committee-Authored Peer-Reviewed Articles in the Past 12 Months:

    Shafi S., E. Priest, C. Klekar, M. Crandall, M. Aboutanos, S. Agarwal, et al. “Multicenter Validation Of American Association for the Surgery of Trauma Grading System for Acute Colonic Diverticulitis and Its Use for Emergency General Surgery Quality Improvement Program,” Journal of Trauma and Acute Care Surgery 80, no. 3 (2016): 405–11.

    Tominaga G., S. Shafi, K. Schuster, S. Savage, S. Ross, P. Miller, P. Muskat, N. Mowery, M. Cohen, D. Ciesla, K. Inaba, C. Brown, S. Agarwal, M. Aboutanos, and M. Crandall. “The American Association for the Surgery of Trauma Grading Scales for Sixteen Emergency General Surgery Conditions: Disease-Specific Criteria Characterizing Anatomic Severity,” Journal of Trauma and Acute Care Surgery 81, no. 3 (2016): 593–602.

    AAST Grading Scale Validation Articles in the Past 12 Months:

    Shafi S., E. Priest, C. Klekar, M. Crandall, M. Aboutanos, S. Agarwal, et al. “Multicenter Validation Of American Association for the Surgery of Trauma Grading System for Acute Colonic Diverticulitis and Its Use for Emergency General Surgery Quality Improvement Program,” Journal of Trauma and Acute Care Surgery 80, no. 3 (2016): 405–11.

    Hernandez, M.C., et al. “Increased Anatomic Severity Predicts Outcomes: Validation of the AAST Emergency General Surgery Score in Appendicitis.” Journal of Trauma and Acute Care Surgery 82, no. 1 (2017): 73–0.

    Baghdadi, et al. “Validation of the Anatomic Severity Score Developed by the AAST in Small Bowel Obstruction.” J Surg Res 204, no. 2 (2016): 428–34

    An option: These changes not only allow for more surgically appropriate billing and coding, but the new documentation more easily aligns with our anatomic grading for risk stratification and research.

     

    Committee Members

    Chair

    • Marie Crandall (2014 - 2017)

    Vice-Chair

    • Garth Utter (2014 - 2017)

    Member

    • Alan Tyroch (2015 - 2018)
    • Ali Salim (2016 - 2019)
    • Babak Sarani (2015 - 2018)
    • Carlos Brown (2014 - 2017)
    • Chris Cribari (2016 - 2019)
    • David Ciesla (2014 - 2017)
    • Gail Tominaga (2014 - 2017)
    • James Davis (2016 - 2019)
    • Joaquim Havens (2015 - 2018)
    • Joaquim Havens (2015 - 2018)
    • John Schulz, III (2014 - 2017)
    • Kevin Schuster (2014 - 2018)
    • Kristan Staudenmayer (2016 - 2019)
    • Lawrence Lottenberg (2015 - 2018)
    • Leonard Weireter, Jr. (2016 - 2019)
    • Leslie Kobayashi (2014 - 2017)
    • Michel Aboutanos (2015 - 2018)
    • Nathan Mowery (2014 - 2017)
    • Robert Winchell (2014 - 2017)
    • Ronald Barbosa (2014 - 2017)
    • Ronald Simon (2016 - 2019)
    • Stephanie Savage (2015 - 2018)
    • Steven Ross (2014 - 2017)
    • Suresh Agarwal, Jr. (2014 - 2017)