The Impact of General Surgeon Supply on the Risk of Appendiceal Rupture in North Carolina
Bibliographic record
Abstract
In Brief Objective: To determine whether individuals from surgery-specific service areas with a low supply of general surgeons (GSs) are at increased risk for ruptured appendicitis (ruptured appendicitis is an indicator of surgical access). Background: The increased health care costs and morbidity linked to appendiceal rupture are considered preventable in most cases with timely access to surgery. Among the factors thought to affect an individual's access to surgery for appendicitis is the relative supply of GSs. The maldistribution of GSs is targeted by a Medicare bonus payment although the impact of GS supply on surgical access has yet to be fully described. Methods: Patients discharged from acute care and ambulatory surgery facilities in North Carolina from 2007 to 2009 were pooled for observational analysis. Using ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes, cases were identified as ruptured or unruptured. GS shortage levels based on supply were calculated at the surgical service area level and tested for an association with an individual's risk of rupture using logistic regression. Results: Living in a service area with less than 3 GSs per 100,000 people significantly increases the probability of rupture in individuals with appendicitis, compared with living in a service area with at least 5 GSs per 100,000. Conclusions: The supply of GSs does affect access to surgical services for appendicitis. Expanding on this finding, the recently instituted HPSA (health professional shortage area) surgical incentive payment from the Affordable Care Act should be evaluated closely for its effectiveness. Enhancing supply in critical shortage areas could reduce appendiceal rupture and improve surgical access more generally. The increased health care costs and morbidity linked to appendiceal rupture are considered preventable in most cases with timely access to surgery. General surgeon shortage levels based on supply were calculated at the surgical service area level and tested for an association with an individual–s risk of rupture using logistic regression. Enhancing supply in critical shortage areas could reduce appendiceal rupture and improve surgical access more generally.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".