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There are emergencies, and there are EMERGENCIES. The former can often wait 24 hours; the latter cannot wait at all. Medicare data does not capture that at all - it only captures the categorical, "surgery type." e.g., someone has a run of the mill cholecystitis that needs to come out. It can go when there's an opening in the surgical schedule, or tomorrow morning. That's an "emergency" - it came in through the ED, wasn't elective. Then there's the person w/ chole that looks septic and you're afraid they're going to perf or already have. That person is going to the OR now. Under Medicare coding, both of those are lap choles, CPT 47562. This doesn't control for that at all, except in the broadest of ways. Also, a 65yo surgical candidate and a 99yo surgical candidate are wildly different. 99yo isn't going under the knife for anything other than immediate threat of death or unendurable pain. In the lap chole example above, I'm going with a trial of abx in the 99yo unless he's absolutely about to perf; 65yo, sure, let's take the gallbladder out - once he's progressed to sx chole, odds are really good it'll have to come out within the next two years. I think most surgeons would rather do it at 65 than 67. Looking at the 2x2 of 65, 99, emergency, and EMERGENCY, you capture an incredibly large variety of severity and risk. |