Take for example, diverticulitis. Patients get the same operation whether they have a complex perforation that causes them to become systemically ill with infection or have a less severe case. The procedure is the same regardless of whether their surgery is delayed or postponed, or whether it's done right away.
Yet all these variables can affect the outcome. The skill of the surgeon can also play a role.
"There's a general feeling that a person will do worse if they require an emergent operation, but there's not a detailed understanding from a research standpoint how much worse," Miller explains. "What particular factors make them do worse, and (for those who do better), what is it about our system that is working?"
Miller emphasizes that the American College of Surgeons has not endorsed his group's registry concept, nor has the National Quality Forum. But within a year, he thinks there will be enough patients loaded into the database that some clear trends will emerge. And they will help his organization see what surgeons and other members of the emergency care team are doing right, and what they might improve.
Down the line, hospitals could look at emergency surgery versus elective surgery for the same procedures on a county or regional or even a statewide basis to get a sense of what influences the best outcomes.
Currently, the most common diagnoses identified include intestinal obstruction, hernia repair, peritonitis, diverticulitis, peptic ulcer disease, and appendicitis.
The need for such a database becomes all the more important as surgeons gravitate to hospital employment, rather than remain independent practitioners who operate on emergency patients only when they are on call, Miller agrees.