F-016THE BURDEN OF FREQUENT EMERGENCY ROOM UTILIZATION AFTER OESOPHAGECTOMY
Bibliographic record
Abstract
Objectives: Oesophagectomy is a complex operation with potential for prolonged recovery. The aim of this study was to evaluate healthcare resource utilization, specifically emergency department (ED) visits within 1 year of oesophagectomy and to identify risk factors for ED visits as well as frequent ED use (FEDU). Methods: A retrospective cohort study of consecutive oesophagectomies for cancer in all Ontario hospitals was conducted using linked health data (2000-2012) including the ability to identify ED visits at non-index hospitals. Ontario has a single-payer healthcare system with a population of 13.8 million people. Multivariable regression was used to identify independent factors associated with ED visits and FEDU (≥3 ED visits) within 1 year after oesophagectomy. Results: There were 3344 oesophagectomies with in-hospital mortality of 5.8% (n = 193). Of those discharged, 16.4% (n = 549), 36.0% (n = 1203) and 55.8% (n = 1866) had ED visits within 30-days, 90-days and 1 year. Higher comorbidity (adjusted odds ratio [aOR]=1.08, 95% CI 1.05–1.11, P < 0.0001), rurality (aOR=1.40, 95% CI 1.10–1.78, P=0.006) and radiation therapy (aOR=4.17, 95% CI 2.75–6.31, P < 0.0001) or chemotherapy (aOR=1.30, 95% CI 1.00–1.69, P=0.048) independently predicted increased ED visits within 1 year of oesophagectomy. Thoracoscopic-assisted surgery was independently associated with decreased ED visits (aOR=0.67, 95% CI 0.45–0.99, P=0.049). Eight hundred and thirteen (24.3%) patients had FEDU. Higher comorbidity (aOR=1.11, 95% CI 1.08–1.14, P < 0.0001), rurality (aOR=1.66, 95% CI 1.31–2.10, P < 0.0001) and radiation therapy (aOR=2.91, 95% CI 2.00–4.23, P < 0.0001) or chemotherapy (aOR=1.41, 95% CI 1.03–1.93, P=0.03) independently predicted FEDU. Older patients were more likely to have FEDU (P < 0.05). One health region had more ED visits (P=0.04) and more FEDU (P=0.001) compared to the other regions. There were higher ED visits and FEDU in the later years of the study period (both P < 0.0001). Conclusions: ED visits are common after oesophagectomy with almost 25% of patients having ≥3 visits and >50% having ≥1 visit within 1 year of oesophagectomy. We have identified demographic, surgical and regional risk factors for potential targeted quality improvement. Disclosure: No significant relationships.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| 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".