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Supplementary AppendixforDuty Hour Reform and the Outcomes of Patients Treated by New SurgeonsRachel R. Kelz, MD, MSCE, MBA, FACSMorgan M. Sellers, MDBijan A. Niknam, BSJames E. Sharpe, MSPaul R. Rosenbaum, PhDAlexander S. Hill, BSHong Zhou, MSLauren L. Hochman, BAKarl Y. Bilimoria, MDKamal Itani, MDPatrick S. Romano, MD, MPHJeffrey H. Silber, MD, PhDFrom the Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (RRK, MMS), The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA (RRK, PRR, JHS), the Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA (BAN, JES, ASH, HZ, JHS, LLH), Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA (PRR), Department of Surgery and Center for Healthcare Studies, Northwestern University, Chicago IL (KYB), VA Boston Health Care System, Boston, MA (KI), Department of Surgery, Boston University School of Medicine, Boston, MA (KI), Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA (PSR), The Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (JHS), Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (JHS), 11Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA (JHS)Table of Contents TOC \o "1-3" \h \z \u eSection1 Algorithm for Assignment of Patients to Surgeons. PAGEREF _Toc536013159 \h 3eSection2. 30-day Resource Cost Algorithm. PAGEREF _Toc536013160 \h 4eSection3. Description of Matching Algorithm. PAGEREF _Toc536013161 \h 7eTable1. List of ICD-9 Principal Procedure Codes and Categories. PAGEREF _Toc536013162 \h 9eTable2. List of Current Procedure Terminology (CPT) Procedure Codes and Categories. PAGEREF _Toc536013163 \h 14eTable3. Patient Selection Summary. PAGEREF _Toc536013164 \h 30eTable4. Risk Models for 30-day Mortality. PAGEREF _Toc536013165 \h 31Table S4a. General Surgery Traditional Era (1999-2003) Risk Model. PAGEREF _Toc536013166 \h 31Table S4b. General Surgery Traditional Era (1999-2003) Risk Model (Comorbidities Only). PAGEREF _Toc536013167 \h 33Table S4c. Orthopedics Traditional Era (1999-2003) Risk Model. PAGEREF _Toc536013168 \h 34Table S4d. Orthopedics Traditional Era (1999-2003) Risk Model (Comorbidities Only). PAGEREF _Toc536013169 \h 35Table S4e. General Surgery Modern Era (2009-9/29/2010) Risk Model. PAGEREF _Toc536013170 \h 36Table S4f. General Surgery Modern Era (2009-9/29/2010) Risk Model (Comorbidities Only). PAGEREF _Toc536013171 \h 38Table S4g. Orthopedics Modern Era (2009-9/29/2010) Risk Model. PAGEREF _Toc536013172 \h 39Table S4h. Orthopedics Modern Era (2009-9/29/2010) Risk Model (Comorbidities Only). PAGEREF _Toc536013173 \h 40Table S4i. General Surgery Modern Era (10/1/2010-2013) Risk Model. PAGEREF _Toc536013174 \h 41Table S4j. General Surgery Modern Era (10/1/2010-2013) Risk Model (Comorbidities Only Model). PAGEREF _Toc536013175 \h 43Table S4k. Orthopedics Modern Era (10/1/2010-2013) Risk Model. PAGEREF _Toc536013176 \h 44Table S4l. Orthopedics Modern Era (10/1/2010-2013) Risk Model (Comorbidities Only). PAGEREF _Toc536013177 \h 45eTable5. Prolonged Length of Stay. PAGEREF _Toc536013178 \h 46eTable6. Pooled Cohort Patient Characteristics. PAGEREF _Toc536013179 \h 47eTable7. Complete Matching Tables. PAGEREF _Toc536013180 \h 49Table S7a. Traditional Era (1999-2003) Match. PAGEREF _Toc536013181 \h 49Table S7b. Modern Era (2009-2013) Match. PAGEREF _Toc536013182 \h 51Table S7c. Traditional Era (1999-2003) General Surgery Match. PAGEREF _Toc536013183 \h 53Table S7d. Traditional Era (1999-2003) Orthopedics Match. PAGEREF _Toc536013184 \h 55Table S7e. Modern Era (2009-2013) General Surgery Match. PAGEREF _Toc536013185 \h 57Table S7f. Modern Era (2009-2013) Orthopedics Match. PAGEREF _Toc536013186 \h 59eTable8. Additional Outcomes Table. PAGEREF _Toc536013187 \h 61References PAGEREF _Toc536013188 \h 62eSection seq NumList \r1 1 Algorithm for Assignment of Patients to Surgeons.First, pull qualifying index admissions by ICD-9 principal procedure code (ICD_PRCDR_CD_1). Bariatric Surgery Screen: Select admissions with ICD-9 principal procedure codes 4382, 4389, 443, 4431, 4438, 4439, 4468, 4469, 4495. In the inpatient bill, check Diagnosis Related Group (DRG) field for a bariatric surgery DRG (619, 620, or 621), or an ICD-9 diagnosis code related to obesity. If either exists, the admission is classified as bariatric. If neither of these conditions are met, re-assign the ICD-9 admissions as follows: 4382: Exclude from the study 4389: reassign to stomach partial gastrectomy 443, 4438, 4439: reassign to stomach gastric bypass (non-bariatric) 4431: Exclude from the study4468: reassign to stomach other4469: reassign to stomach other 4495: Exclude from the studyFor all other refined PPX categories, link them to a qualifying CPT code from the same ICD-9 category: First, look for a CPT bill from the exact same narrow PPX category, as follows:If a single qualifying CPT bill from the same narrow category as the ICD-9 PPX appeared on the same day, assign the admission to that Surgeon. If multiple CPT bills from the same narrow category as the ICD-9 PPX appear on the same day, assign the patient to the Surgeon who submitted the highest-revenue bill. If one or more qualifying CPT bill from the same narrow category did not occur on the same day, but were submitted on a different day, assign the patient to the Surgeon who submitted the first CPT bill during the hospitalization, and reassign the patient to that bill’s CPT-based narrow category. If no qualifying bills from the same narrow category appear, revert to checking for any CPT bill from the same broad CPT category, as follows:If a single CPT bill from the same broad category as the ICD-9 PPX occurred on the same day as the ICD-9 PPX, assign the patient to that Surgeon, and reassign the patient to that bill’s CPT-based narrow category. ADDIN EN.CITE <EndNote><Cite><Author>Fingar</Author><Year>2014</Year><RecNum>17809</RecNum><DisplayText><style face="superscript" font="Times New Roman">1</style></DisplayText><record><rec-number>17809</rec-number><foreign-keys><key app="EN" db-id="2p9r50swh2ddw8e2x22xzdfhpea502r29wtw" timestamp="1523037990">17809</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Fingar, K. R.</author><author>Stocks, C.</author><author>Weiss, A. J.</author><author>Steiner, C. A.</author></authors></contributors><titles><title>Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012</title></titles><number>HCUP Statistical Brief #186</number><dates><year>2014</year><pub-dates><date>December</date></pub-dates></dates><pub-location>Rockville, MD</pub-location><publisher>Agency for Healthcare Research and Quality</publisher><urls><related-urls><url> 4, 2018</access-date></record></Cite></EndNote>1If multiple CPT bills from the same broad category as the ICD-9 PPX occurred on the same day as the ICD-9 PPX, then assign the patient to the Surgeon who submitted the highest-revenue bill, and reassign the patient to that bill’s CPT-based narrow category. If one or more qualifying CPT bills from the same broad category as the ICD-9 PPX did not occur on the same day, but were submitted on a different day than the ICD-9 PPX, assign the patient to the Surgeon who submitted the first such bill during the hospitalization, and reassign the patient to that bill’s CPT-based narrow category. eSection seq NumList 2. 30-day Resource Cost Algorithm.A. Exclusions for Non-Acute CareInpatient Hospital (Part A) FileExclude claim for hospitalizations in non-acute settings using 6-digit Medicare hospital ID (hospital identified as other than “Short-term (General and Specialty) Hospital” or “Critical Access Hospital”)Exclude if the 3rd position of the ID is not equal to “0” or if the 3rd and 4th positions are not equal to “13”Exclude if 4th, 5th, or 6th position in identifier is not a numberExclude claim if DRG = 945 or 946 (Rehabilitation) Outpatient FileExclude claim for encounters in non-acute settings using 6-digit Medicare hospital ID (hospital identified as other than “Short-term (General and Specialty) Hospital” or “Critical Access Hospital”)Exclude if the 3rd position of the ID is not equal to “0” or if the 3rd and 4th positions are not equal to “13”Exclude if 4th, 5th, or 6th position in identifier is not a numberExclude claim if principal diagnosis = V57 or subterms (Care involving use of rehabilitation procedures)Surgeon/Carrier (Part B) FileExclude any claim if the from and through dates fall on or between the admission and discharge dates of a non-acute hospitalization (as defined above) or between the from and through dates of a claim for outpatient care in a non-acute hospitalExclude claim if no line item place of service codes from the following list appear:11 = Office15 = Mobile Unit 20 = Urgent Care Facility 21 = Inpatient hospital22 = Outpatient hospital23 = Emergency room - hospital24 = Ambulatory surgical center41 = Ambulance - land42 = Ambulance - air or water50 = Federally qualified health centers65 = End stage renal disease treatment facility71 = State or local public health clinic Independent laboratoryExclude claim if principal diagnosis = V57 or subterms (Care involving use of rehabilitation procedures)B. Resource Utilization-Based Cost AccountingFacility and Accommodation Costs from the Inpatient File:Accommodations:Determine number of inpatient critical care and non-critical care days from revenue centers in the Inpatient file.Multiply number of critical care/non-critical care days by average daily cost for each type (adjust to 2013 values using the Bureau of Labor & Statistics inflation factor, hospital component - CCM: $4,627.52; Int-CCM: $3,072.08; Non-CCM: $1,516.64)Non-Critical CareRevenue CentersIntermediate CareRevenue CentersCritical CareRevenue Centers0100-0101 All-inclusive rate-room and board0206Intermediate care0200-0205Intensive care0110-0119 Private medical or general0207-0209Intensive care0120-0129 Semi-private 2 bed (medical or general)0210-0213,Coronary care0130-0139 Semi-private 3 and 4 beds0219 Coronary care0140-0149 Private (deluxe)0150-0159 Room & Board ward (medical or general)0160, 0164, 0167 Other Room & BoardOperating Room Time Cost (index admission only)Determine operating room time using “best anesthesia chart time,” if available; If best anesthesia time missing, use claim anesthesia time from Surgeon/Carrier (Part B) file; if both best chart time and claim time missing, assign each patient median best anesthesia time by procedureMultiply anesthesia time by mean of OR time cost range and inflate to 2013 dollars ($21.20/minute)Emergency Room Visit Fixed Costs (post-discharge only)For post-discharge Part B records only, separate records into line items and locate place of service code 23 (“Emergency Room – Hospital”)Treat each unique ER date as separate visit, sum visits per patientMultiply by average ER visit cost, inflated to 2013 dollars ($526.90)Service Costs from Carrier/Part B and Outpatient Files: (Note: Office visits, Home Care, SNF, and non-ER Outpatient use only section 2 methods)Separate line items from Part B (each includes patient ID, CPT code, units count, place of service)Anesthesia - if first two digits of CPT code are 00 or 01, code indicates anesthesia billingApply standard CMS base units (2013 list) to each CPT code; if applicable, anesthesia modifier AD reduces base units to 3 per procedure for medical supervisionSince time units count reflects anesthesia time in minutes divided by 1.5, divide reported time by 10 to determine number of 15-minute anesthesia time unitsAdd base and time units for each line item, multiply by $21.92 (un-weighted mean of locality conversion factors, number needs to be revised once national CF available); If applicable, anesthesia modifier QK reduces total AVUs by 50% of allowed rate for medical direction of multiple proceduresSum anesthesia line item costs by patientOther Services - apply method to all non-anesthesia Part B line itemsMerge line item CPT with AMA CPT/RVU list (2013 file) to determine RVU for eachUsing place of service codes, determine whether facility or non-facility RVU is appropriate – for this cost estimate, treat outpatient hospitals as “non-facility” sites of care to adjust for facility component of service costsMultiply RVUs by line item service count (=1 in 99% of non-anesthesia cases)Multiply total RVUs by conversion factor ($34.02 in 2013)Sum line item costs by patientTime Frame Under Assessment for Resource Utilization-based Cost Accounting:In-hospital costs account for all patient claims during the time period of the index hospitalization30-day costs account for all in-hospital costs, plus any other bills (ER visits, and any bills in the Outpatient and Carrier/Part B files) that occurred within 30 days of admission, and any bills accrued during the entirety of any readmission that began within 30 days of admission.Summary Equation: QUOTE = Number of days in critical care QUOTE = Number of days in intermediate care QUOTE = Number of days on hospital floor QUOTE = Number of minutes in operating room AU = Number of anesthesia unitsER = Number of emergency room days QUOTE = Number of all j RVUs from all bills over defined time period that includes all outpatient and office visits RC = Readmission costs—all costs associated with hospitalization that began within 30 days of readmission eSection seq NumList 3. Description of Matching Algorithm.The Surgeon MatchWe first formed surgeon pairs practicing in the same hospital using a distance function. The function only included the procedures performed. Using the 10 randomly sampled patients for each new surgeon, new surgeons were optimally paired to the experienced surgeon who performed at least as many of the same procedures. The Patient MatchAfter pairing new and experienced surgeons in the two eras, we then matched their patients within each era. Patients were matched within the hospital and within surgeon pair, and we used Refined Balance ADDIN EN.CITE <EndNote><Cite><Author>Pimentel</Author><Year>2015</Year><RecNum>17024</RecNum><DisplayText><style face="superscript" font="Times New Roman">2</style></DisplayText><record><rec-number>17024</rec-number><foreign-keys><key app="EN" db-id="2p9r50swh2ddw8e2x22xzdfhpea502r29wtw" timestamp="1408555277">17024</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pimentel, S. D.</author><author>Kelz, R. R.</author><author>Silber, J. H.</author><author>Rosenbaum, P. R.</author></authors></contributors><titles><title>Large, sparse optimal matching with refined covariate balance in an observational study of the health outcomes produced by new surgeons</title><secondary-title>J Am Stat Assoc</secondary-title></titles><periodical><full-title>J Am Stat Assoc</full-title></periodical><pages>515-527</pages><volume>110</volume><number>510</number><edition>Jan. 23, 2015</edition><dates><year>2015</year><pub-dates><date>Jul 6,</date></pub-dates></dates><accession-num>26273117</accession-num><urls></urls><custom2>4531000</custom2></record></Cite></EndNote>2 to balance the marginal distributions of procedure types, 14 comorbidities (in italics below), admission type, and transfer status as closely as possible. We also near-exact matched for procedure types by placing them in a Mahalanobis distance.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWhhbGFub2JpczwvQXV0aG9yPjxZZWFyPjE5MzY8L1ll
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ZXM+PHZvbHVtZT4zNjwvdm9sdW1lPjxudW1iZXI+MjwvbnVtYmVyPjxkYXRlcz48eWVhcj4xOTgw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=
ADDIN EN.CITE.DATA 3-5 All refined balance covariates were also placed in the Mahalanobis distance, which was minimized in matched pairs subject to the near-exact and refined balance constraints. The distance also included 16 additional comorbidities (for a total of 30), number of comorbidities per patient, categories of secondary procedures on the same day as the principal procedure, a propensity score for treatment by a new surgeon with a caliper to discourage paired differences in propensity scores greater than 0.2 SDs, and risk scores for 30-day mortality.List of Matching CovariatesPrincipal Procedure CategoryDemographic VariablesAge on admission, in yearsAge 65-69Age 70-74Age 75-79Age 80-84Age 85+SexAdmission YearIn the Modern era, patients were exact matched for admission on or prior to 9/30/2010, and also matched for admission in 2012-2013.Admission CharacteristicsEmergent type admissionTransfer-in Hospitalization in 6 months prior to admissionSecondary Procedures on Same DayMajor operative secondary procedureComorbidities (italicized ones are in both the Mahalanobis distance and refined balance hierarchy)Congestive heart failurePast myocardial infarctionPast arrhythmiaAnginaValvular diseaseUnstable anginaHypertensionDiabetesRenal dysfunctionRenal failureLiver diseaseCancerSpecific abdominal cancerChronic obstructive pulmonary diseaseAsthmaPost-inflammatory pulmonary fibrosisDementiaStrokeSeizureParaplegiaHypothyroidismCollagen vascular diseaseHemoglobinopathyAIDSChronic peptic ulcerCoagulopathyOther coagulopathyCushing’s diseaseGraves’ diseaseThrombocytopeniaScoresPropensity score for treatment by a new surgeonRisk of 30-day mortality (using all patient risk factors), using different models before and after 9/30/2010. Risk of 30-day mortality (using comorbidities only), using different models before and after 9/30/2010. Comorbidity counteTable seq NumList \r1 1. List of ICD-9 Principal Procedure Codes and Categories.Surgical GroupICD-9 CodeICD-9 LabelProcedure CategoryBroad CategoryGeneral Surgery0722Unilateral adrenalectomyAdrenalectomyadrenalGeneral Surgery0729Other partial adrenalectomyAdrenalectomyadrenalGeneral Surgery073Bilateral adrenalectomyAdrenalectomyadrenalGeneral Surgery4701Laparoscopic appendectomyAppendectomybowelGeneral Surgery4709Other appendectomyAppendectomybowelGeneral Surgery4382Laparoscopic vertical (sleeve) gastrectomyBariatricbariatricGeneral Surgery4389Other partial gastrectomy, otherBariatricbariatricGeneral Surgery443Gastroenterostomy without gastrectomyBariatricbariatricGeneral Surgery4431High gastric bypassBariatricbariatricGeneral Surgery4438Laparoscopic gastroenterostomyBariatricbariatricGeneral Surgery4439Other gastroenterostomyBariatricbariatricGeneral Surgery4468Laparoscopic gastroplastyBariatricbariatricGeneral Surgery4469Other repair of stomach, otherBariatricbariatricGeneral Surgery4495Laparoscopic gastric restrictive procedureBariatricbariatricGeneral Surgery5141Common duct exploration for removal of calculusBiliary common ductHPBGeneral Surgery5151Exploration of common ductBiliary common ductHPBGeneral Surgery5132Anastomosis of gallbladder to intestineBiliary otherHPBGeneral Surgery5136CholedochoenterostomyBiliary otherHPBGeneral Surgery5137Anastomosis of hepatic duct to gastrointestinal tractBiliary otherHPBGeneral Surgery5122CholecystectomyCholecystectomyHPBGeneral Surgery5123Laparoscopic cholecystectomyCholecystectomyHPBGeneral Surgery5124Laparoscopic partial cholecystectomyCholecystectomyHPBGeneral Surgery1731Laparoscopic multiple segmental resection of large intestineColectomy Partial - LapbowelGeneral Surgery1732Laparoscopic cecectomyColectomy Partial - LapbowelGeneral Surgery1733Laparoscopic right hemicolectomyColectomy Partial - LapbowelGeneral Surgery1734Laparoscopic resection of transverse colonColectomy Partial - LapbowelGeneral Surgery1735Laparoscopic left hemicolectomyColectomy Partial - LapbowelGeneral Surgery1736Laparoscopic sigmoidectomyColectomy Partial - LapbowelGeneral Surgery1739Other laparoscopic partial excision of large intestineColectomy Partial - LapbowelGeneral Surgery4571Open and other multiple segmental resection of large intestineColectomy Partial – OpenbowelGeneral Surgery4572Open and other cecectomyColectomy Partial – OpenbowelGeneral Surgery4573Open and other right hemicolectomyColectomy Partial – OpenbowelGeneral Surgery4574Open and other resection of transverse colonColectomy Partial – OpenbowelGeneral Surgery4575Open and other left hemicolectomyColectomy Partial – OpenbowelGeneral Surgery4576Open and other sigmoidectomyColectomy Partial – OpenbowelGeneral Surgery4579Other and unspecified partial excision of large intestineColectomy Partial – OpenbowelGeneral Surgery4581Laparoscopic total intra-abdominal colectomyColectomy Total - LapbowelGeneral Surgery458Total intra-abdominal colectomyColectomy Total - OpenbowelGeneral Surgery4582Open total intra-abdominal colectomyColectomy Total - OpenbowelGeneral Surgery4583Other and unspecified total intra-abdominal colectomyColectomy Total - OpenbowelGeneral Surgery4240Esophagectomy, not otherwise specifiedEsophagectomyUGIGeneral Surgery4241Partial esophagectomyEsophagectomyUGIGeneral Surgery4242Total esophagectomyEsophagectomyUGIGeneral Surgery427EsophagomyotomyEsophagomyotomyUGIGeneral Surgery5342Laparoscipic repair of umbilical hernia with graft or prosthesisHernia Abdominal – LapHerniaGeneral Surgery5343Other laparoscopic umbilical herniorrhaphyHernia Abdominal – LapHerniaGeneral Surgery5362Laparoscopic incisional hernia repair with graft or prosthesisHernia Abdominal – LapHerniaGeneral Surgery5363Other laparoscopic repair of other hernia of anterior abdominal wall with graft or prosthesisHernia Abdominal – LapHerniaGeneral Surgery5341Other and open repair of umbilical hernia with graft or prosthesisHernia Abdominal – Open HerniaGeneral Surgery5349Other open umbilical herniorrhaphyHernia Abdominal – Open HerniaGeneral Surgery5351Incisional hernia repairHernia Abdominal – Open HerniaGeneral Surgery5359Repair of other hernia of anterior abdominal wallHernia Abdominal – Open HerniaGeneral Surgery5361Other open incisional hernia repair with graft or prosthesisHernia Abdominal – Open HerniaGeneral Surgery5369Other and open repair of other hernia of anterior abdominal wall with graft or prosthesisHernia Abdominal – Open HerniaGeneral Surgery1711Laparoscopic repair of direct inguinal hernia with graft or prosthesisHernia Groin – Lap HerniaGeneral Surgery1712Laparoscopic repair of indirect inguinal hernia with graft or prosthesisHernia Groin – Lap HerniaGeneral Surgery1713Laparoscopic repair of inguinal hernia with graft or prosthesis, not otherwise specifiedHernia Groin – Lap HerniaGeneral Surgery1721Laparoscopic bilateral repair of direct inguinal hernia with graft or prosthesisHernia Groin – Lap HerniaGeneral Surgery1722Laparoscopic bilateral repair of indirect inguinal hernia with graft or prosthesisHernia Groin – Lap HerniaGeneral Surgery1723Laparoscopic bilateral repair of inguinal hernia, one direct and one indirect, with graft or prosthesisHernia Groin – Lap HerniaGeneral Surgery1724Laparoscopic bilateral repair of inguinal hernia with graft or prosthesis, not otherwise specifiedHernia Groin – Lap HerniaGeneral Surgery5300Unilateral repair of inguinal hernia, not otherwise specifiedHernia Groin – OpenHerniaGeneral Surgery5301Other and open repair of direct inguinal herniaHernia Groin – OpenHerniaGeneral Surgery5302Other and open repair of indirect inguinal herniaHernia Groin – OpenHerniaGeneral Surgery5303Other and open repair of direct inguinal hernia with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5304Other and open repair of indirect inguinal hernia with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5305Repair of inguinal hernia with graft or prosthesis, not otherwise specifiedHernia Groin – OpenHerniaGeneral Surgery5310Bilateral repair of inguinal hernia, not otherwise specifiedHernia Groin – OpenHerniaGeneral Surgery5311Other and open bilateral repair of direct inguinal herniaHernia Groin – OpenHerniaGeneral Surgery5312Other and open bilateral repair of indirect inguinal herniaHernia Groin – OpenHerniaGeneral Surgery5313Other and open bilateral repair of inguinal hernia, one direct and one indirectHernia Groin – OpenHerniaGeneral Surgery5314Other and open bilateral repair of direct inguinal hernia with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5315Other and open bilateral repair of indirect inguinal hernia with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5316Other and open bilateral repair of inguinal hernia, one direct and one indirect, with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5317Bilateral inguinal hernia repair with graft or prosthesis, not otherwise specifiedHernia Groin – OpenHerniaGeneral Surgery5321Unilateral repair of femoral hernia with graft or prosthesisHernia Groin – OpenHerniaGeneral Surgery5329Other unilateral femoral herniorrhaphyHernia Groin – OpenHerniaGeneral Surgery459Instestinal anastomosisLarge Bowel OtherbowelGeneral Surgery4590Intestinal anastomosis, not otherwise specifiedLarge Bowel OtherbowelGeneral Surgery4592Anastomosis of small intestine to rectal stumpLarge Bowel OtherbowelGeneral Surgery4593Other small-to-large intestinal anastomosisLarge Bowel OtherbowelGeneral Surgery4594Large-to-large intestinal anastomosisLarge Bowel OtherbowelGeneral Surgery4595Anastomosis to anusLarge Bowel OtherbowelGeneral Surgery4675Suture of laceration of large intestineLarge Bowel OtherbowelGeneral Surgery4679Other repair of intestineLarge Bowel OtherbowelGeneral Surgery5029Other destruction of lesion of liverLiver OtherHPBGeneral Surgery5022Partial hepatectomyLiver Partial HepatectomyHPBGeneral Surgery503Lobectomy of liverLiver Partial HepatectomyHPBGeneral Surgery5451Laparoscopic lysis of peritoneal adhesionsLysis of AdhesionsbowelGeneral Surgery5459Other lysis of peritoneal adhesionsLysis of AdhesionsbowelGeneral Surgery8541Unilateral simple mastectomyMastectomyBreastGeneral Surgery8542Unilateral simple mastectomyMastectomyBreastGeneral Surgery8543Unilateral extended simple mastectomyMastectomyBreastGeneral Surgery8544Bilateral extended simple mastectomyMastectomyBreastGeneral Surgery8545Unilateral radical mastectomyMastectomyBreastGeneral Surgery8546Bilateral radical mastectomyMastectomyBreastGeneral Surgery8547Unilateral extended radical mastectomyMastectomyBreastGeneral Surgery8548Bilateral extended radical mastectomyMastectomyBreastGeneral Surgery5251Proximal pancreatectomyPancreatectomyHPBGeneral Surgery5252Distal pancreatectomyPancreatectomyHPBGeneral Surgery5253Radical subtotal pancreatectomyPancreatectomyHPBGeneral Surgery5259Other partial pancreatectomyPancreatectomyHPBGeneral Surgery526Total pancreatectomyPancreatectomyHPBGeneral Surgery527Radical pancreaticoduodenectomyPancreatectomyHPBGeneral Surgery0681Complete parathyroidectomyParathyroidectomyEndocrineGeneral Surgery0689Other parathyroidectomyParathyroidectomyEndocrineGeneral Surgery5493Creation of cutaneoperitoneal fistulaPD Access ProcedureBowelGeneral Surgery4849Other pull-through resection of rectumProctectomyBowelGeneral Surgery485Abdominoperineal resection of rectumProctectomyBowelGeneral Surgery4850Abdominoperineal resection of the rectum, not otherwise specifiedProctectomyBowelGeneral Surgery4851Laparoscopic abdominoperineal resection of the rectumProctectomyBowelGeneral Surgery4852Open abdominoperineal resection of the rectumProctectomyBowelGeneral Surgery4859Other abdominoperineal resection of the rectumProctectomyBowelGeneral Surgery4862Anterior resection of rectum with synchronous colostomyProctectomyBowelGeneral Surgery4863Other anterior resection of rectumProctectomyBowelGeneral Surgery4869Other resection of rectumProctectomyBowelGeneral Surgery4875Abdominal proctopexyProctopexyBowelGeneral Surgery4429Other pyloroplastyPyloroplastyBowelGeneral Surgery4591Small-to-small intestinal anastomosisSmall Bowel OtherBowelGeneral Surgery4673Suture of laceration of small intestine, except duodenumSmall Bowel OtherBowelGeneral Surgery4674Closure of fistula of small intestine, except duodenumSmall Bowel OtherBowelGeneral Surgery4679Other repair of intestineSmall Bowel OtherBowelGeneral Surgery4551Isolation of segment of small intestineSmall Bowel ResectionBowelGeneral Surgery4561Multiple segmental resection of small intestineSmall Bowel ResectionBowelGeneral Surgery4562Other partial resection of small intestineSmall Bowel ResectionBowelGeneral Surgery415Total splenectomySplenectomyHPBGeneral Surgery4466Other procedures for creation of esophagogastric sphincteric competenceStomach Anti-RefluxUGIGeneral Surgery4467Laparoscopic procedures for creation of esophagogastric sphincteric competenceStomach Anti-RefluxUGIGeneral Surgery443Gastroenterostomy without gastrectomyStomach Gastric Bypass (non-bariatric)UGIGeneral Surgery4438Laparoscopic gastroenterostomyStomach Gastric Bypass (non-bariatric)UGIGeneral Surgery4439Other gastroenterostomyStomach Gastric Bypass (non-bariatric)UGIGeneral Surgery4342Local excision of other lesion or tissue of stomachStomach OtherUGIGeneral Surgery4469Other repair of stomach, otherStomach OtherUGIGeneral Surgery435Partial gastrectomy with anastomosis to esophagusStomach Partial GastrectomyUGIGeneral Surgery436Partial gastrectomy with anastomosis to duodenumStomach Partial GastrectomyUGIGeneral Surgery437Partial gastrectomy with anastomosis to jejunumStomach Partial GastrectomyUGIGeneral Surgery4389Other partial gastrectomy, otherStomach Partial GastrectomyUGIGeneral Surgery4399Other total gastrectomyStomach Total GastrectomyUGIGeneral Surgery062Unilateral thyroid lobectomyThyroidectomy PartialEndocrineGeneral Surgery0631Excision of lesion of thyroidThyroidectomy PartialEndocrineGeneral Surgery0639Other partial thyroidectomyThyroidectomy PartialEndocrineGeneral Surgery0650Substernal thyroidectomy, not otherwise specifiedThyroidectomy SubsternalEndocrineGeneral Surgery0651Partial substernal thyroidectomyThyroidectomy SubsternalEndocrineGeneral Surgery0652Complete substernal thyroidectomyThyroidectomy SubsternalEndocrineGeneral Surgery064Complete thyroidectomyThyroidectomy TotalEndocrineGeneral Surgery4441Suture of gastric ulcer siteUlcerbowelGeneral Surgery4442Suture of duodenal ulcer siteUlcerbowelOrthopedic Surgery7935Open reduction with internal fixation, femurHip RepairorthoOrthopedic Surgery8140Repair of hip, not elsewhere classifiedHip RepairorthoOrthopedic Surgery8151Total hip arthroplastyHip ReplacementorthoOrthopedic Surgery8152Partial hip arthroplastyHip ReplacementorthoOrthopedic Surgery0070Revision of hip replacement, both acetabular and femoral componentsHip Replacement RevisionorthoOrthopedic Surgery0071Revision of hip replacement, acetabular componentHip Replacement RevisionorthoOrthopedic Surgery0072Revision of hip replacement, femoral componentHip Replacement RevisionorthoOrthopedic Surgery0073Revision of hip replacement, acetabular liner and/or femoral head onlyHip Replacement RevisionorthoOrthopedic Surgery8153Revision of hip replacement, not otherwise specifiedHip Replacement RevisionorthoOrthopedic Surgery8154Total knee replacementKnee ReplacementorthoOrthopedic Surgery0080Revision of knee replacement, total (all components)Knee Replacement RevisionorthoOrthopedic Surgery0081Revision of knee replacement, tibial componentKnee Replacement RevisionorthoOrthopedic Surgery0082Revision of knee replacement, femoral componentKnee Replacement RevisionorthoOrthopedic Surgery0083Revision of knee replacement, patellar componentKnee Replacement RevisionorthoOrthopedic Surgery0084Revision of total knee replacement, tibial insert (liner)Knee Replacement RevisionorthoOrthopedic Surgery8155Revision of knee replacement, not otherwise specifiedKnee Replacement RevisionorthoeTable seq NumList 2. List of Current Procedure Terminology (CPT) Procedure Codes and Categories.Surgical TypeProcedure CategoryCPT CodeCPT LabelBroad CategoryGeneral SurgeryAdrenalectomy44950AppendectomyAdrenalGeneral SurgeryAdrenalectomy44960Appendectomy for ruptured appendixAdrenalGeneral SurgeryAdrenalectomy44970Laparoscopy, surgical, appendectomyAdrenalGeneral SurgeryAdrenalectomy56315Laparoscopy, surgical; appendectomyAdrenalGeneral SurgeryAdrenalectomy56321Laparoscopy, surgical; with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsalAdrenalGeneral SurgeryAdrenalectomy60540Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsyAdrenalGeneral SurgeryAdrenalectomy60545Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy; with excision of adjacent retroperitoneal tumorAdrenalGeneral SurgeryAdrenalectomy60550Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsyAdrenalGeneral SurgeryAdrenalectomy60650Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsalAdrenalGeneral SurgeryBariatric43631Gastrectomy, partial, distal; with gastroduodenostomyBariatricGeneral SurgeryBariatric43632Gastrectomy, partial, distal; with gastrojejunostomyBariatricGeneral SurgeryBariatric43633Gastrectomy, partial, distal; with Roux-en-Y reconstructionBariatricGeneral SurgeryBariatric43634Gastrectomy, partial, distal; with formation of intestinal pouchBariatricGeneral SurgeryBariatric43644Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)BariatricGeneral SurgeryBariatric43645Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorptionBariatricGeneral SurgeryBariatric43770Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)BariatricGeneral SurgeryBariatric43775Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)BariatricGeneral SurgeryBariatric43842Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplastyBariatricGeneral SurgeryBariatric43843Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplastyBariatricGeneral SurgeryBariatric43844Gastric bypass, other than with Roux-en-Y gastroenterostomy, for morbid obesityBariatricGeneral SurgeryBariatric43845Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)BariatricGeneral SurgeryBariatric43846Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomyBariatricGeneral SurgeryBariatric43847Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorptionBariatricGeneral SurgeryBiliary Common Duct47420Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; without transduodenal sphincterotomy or sphincteroplastyHPBGeneral SurgeryBiliary Common Duct47425Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; with transduodenal sphincterotomy or sphincteroplastyHPBGeneral SurgeryBiliary Common Duct47564Laparoscopy, surgical; cholecystectomy with exploration of common ductHPBGeneral SurgeryBiliary Common Duct47610Cholecystectomy with exploration of common ductHPBGeneral SurgeryBiliary Common Duct47612Cholecystectomy with exploration of common duct; with choledochoenterostomyHPBGeneral SurgeryBiliary Common Duct47620Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiographyHPBGeneral SurgeryBiliary Common Duct56342Laparoscopy, cholecystectomy with exploration of common ductHPBGeneral SurgeryBiliary Other46324Laparoscopy, surgical; cholecystoenterostomyHPBGeneral SurgeryBiliary Other47570Laparoscopy, surgical; cholecystoenterostomyHPBGeneral SurgeryBiliary Other47612Cholecystectomy with exploration of common duct; with choledochoenterostomyHPBGeneral SurgeryBiliary Other47720Cholecystoenterostomy; directHPBGeneral SurgeryBiliary Other47721Cholecystoenterostomy; with gastroenterostomyHPBGeneral SurgeryBiliary Other47740Cholecystoenterostomy; roux-en-yHPBGeneral SurgeryBiliary Other47741Cholecystoenterostomy; roux-en-y with gastroenterostomyHPBGeneral SurgeryBiliary Other47760Anastomosis, of extrahepatic biliary ducts and gastrointestinal tractHPBGeneral SurgeryBiliary Other47765Anastomosis, of intrahepatic biliary ducts and gastrointestinal tractHPBGeneral SurgeryBiliary Other47780Anastomosis, roux-en-y,of extrahepatic biliary ducts and gastrointestinal tractHPBGeneral SurgeryBiliary Other47785Anastomosis, roux-en-y, of intrahepatic biliary ducts and gastrointestinal tractHPBGeneral SurgeryBiliary Other56324Laparoscopy, surgical; with cholecystoenterostomyHPBGeneral SurgeryCholecystectomy47562Laparoscopy, surgical; cholecystectomyHPBGeneral SurgeryCholecystectomy47563Laparoscopy, surgical; cholecystectomy with cholangiographyHPBGeneral SurgeryCholecystectomy47600CholecystectomyHPBGeneral SurgeryCholecystectomy47605Cholecystectomy with cholangiographyHPBGeneral SurgeryCholecystectomy56340Laparoscopy, cholecystectomy (any method)HPBGeneral SurgeryCholecystectomy56341Laparoscopy, cholecystectomy with cholangiographyHPBGeneral SurgeryCholecystectomy56342Laparoscopy, cholecystectomy with exploration of common ductHPBGeneral SurgeryColectomy Partial - Lap44204Laparoscopy, surgical; colectomy, partial, with anastomosisBowelGeneral SurgeryColectomy Partial - Lap44205Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomyBowelGeneral SurgeryColectomy Partial - Lap44206Laparoscopy, surgical; colectomy, partial with end colostomy and closure of distal segment (Hartmann)BowelGeneral SurgeryColectomy Partial - Lap44207Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)BowelGeneral SurgeryColectomy Partial - Lap44208Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomyBowelGeneral SurgeryColectomy Partial - Open44130Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)BowelGeneral SurgeryColectomy Partial - Open44140Colectomy, partial; with anastomosisBowelGeneral SurgeryColectomy Partial - Open44141Colectomy, partial; with skin level cecostomy or colostomyBowelGeneral SurgeryColectomy Partial - Open44143Colectomy, partial; with end colostomy and closure of distal segmentBowelGeneral SurgeryColectomy Partial - Open44144Colectomy, partial; with colostomy or ileostomy and creation of mucofistulaBowelGeneral SurgeryColectomy Partial - Open44145Colectomy, partial; with coloproctostomy (low pelvic anastomosis)BowelGeneral SurgeryColectomy Partial - Open44146Colectomy, partial; with coloproctostomy (low pelvic anastomosis) with colostomyBowelGeneral SurgeryColectomy Partial - Open44147Colectomy, partial; abdominal and transanal approachBowelGeneral SurgeryColectomy Partial - Open44160Colectomy, partial, with removal of terminal ileum with ileocolostomyBowelGeneral SurgeryColectomy Partial - Open44625Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectalBowelGeneral SurgeryColectomy Partial - Open44626Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)BowelGeneral SurgeryColectomy Total - Lap44210Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomyBowelGeneral SurgeryColectomy Total - Lap44211Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoirBowelGeneral SurgeryColectomy Total - Lap44212Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomyBowelGeneral SurgeryColectomy Total - Open44150Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomyBowelGeneral SurgeryColectomy Total - Open44151Colectomy, total, abdominal without proctectomy; with continent ileostomyBowelGeneral SurgeryColectomy Total - Open44152Colectomy, total, abdominal, without proctectomy; with rectal mucosectomy, ileoanal anastomosis, with or without loop ileostomyBowelGeneral SurgeryColectomy Total - Open44153Colectomy, total, abdominal, without proctectomy; with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomyBowelGeneral SurgeryColectomy Total - Open44155Colectomy, total, abdominal, with proctectomy; with ileostomyBowelGeneral SurgeryColectomy Total - Open44156Colectomy, total, abdominal, with proctectomy; with continent ileostomyBowelGeneral SurgeryColectomy Total - Open44157Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosisBowelGeneral SurgeryColectomy Total - Open44158Colectomy, total, abdominal, with proctectomy; with ileoanal anastomosis, creation of ileal reservoirBowelGeneral SurgeryEsophagectomy43107Total or near total esophagectomyUGIGeneral SurgeryEsophagectomy43108Esophagectomy with colon interpositionUGIGeneral SurgeryEsophagectomy43112Esophagectomy with thoracotomyUGIGeneral SurgeryEsophagectomy43113Esophagectomy with thoracotomy and colon interpositionUGIGeneral SurgeryEsophagectomy43116Partial esophagectomy, cervicalUGIGeneral SurgeryEsophagectomy43117Partial esophagectomy (Ivor Lewis)UGIGeneral SurgeryEsophagectomy43118Partial esophagectomy (Ivor Lewis) with colon interpositionUGIGeneral SurgeryEsophagectomy43121Partial esophagectomy, distal two-thirds, with thoracotomy onlyUGIGeneral SurgeryEsophagectomy43122Partial esophagectomy, thoracoabdominal or abdominal approachUGIGeneral SurgeryEsophagectomy43123Partial esophagectomy, thoracoabdominal or abdominal approach, with colon interpositionUGIGeneral SurgeryEsophagectomy43124Total or partial esophagectomy with cervical esophagostomyUGIGeneral SurgeryEsophagomyotomy32665Thoracoscopy, surgical; with esophagomyotomy (Heller type)UGIGeneral SurgeryEsophagomyotomy43279Laparoscopic esophagomyotomyUGIGeneral SurgeryEsophagomyotomy43279Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performedUGIGeneral SurgeryEsophagomyotomy43330Esophagomyotomy; abdominal approachUGIGeneral SurgeryEsophagomyotomy43331Esophagomyotomy; thoracic approachUGIGeneral SurgeryHernia Abdominal – Lap49652Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducibleHerniaGeneral SurgeryHernia Abdominal – Lap49653Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Lap49654Laparoscopy, surgical, repair, incisional hernia; reducibleHerniaGeneral SurgeryHernia Abdominal – Lap49655Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Lap49656Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducibleHerniaGeneral SurgeryHernia Abdominal – Lap49657Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Open49560Repair initial incisional or ventral hernia; reducibleHerniaGeneral SurgeryHernia Abdominal – Open49561Repair initial incisional or ventral hernia; incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Open49565Repair recurrent incisional or ventral hernia; reducibleHerniaGeneral SurgeryHernia Abdominal – Open49566Repair recurrent incisional or ventral hernia; incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Open49570Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)HerniaGeneral SurgeryHernia Abdominal – Open49572Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Open49585Repair umbilical hernia, age 5 years or over; reducibleHerniaGeneral SurgeryHernia Abdominal – Open49587Repair umbilical hernia, age 5 years or older; incarcerated or strangulatedHerniaGeneral SurgeryHernia Abdominal – Open49590Repair spigelian herniaHerniaGeneral SurgeryHernia Groin – Lap 49650Laparoscopy, surgical; repair initial inguinal herniaherniaGeneral SurgeryHernia Groin – Lap 49651Laparoscopy, surgical; repair recurrent inguinal herniaherniaGeneral SurgeryHernia Groin – Lap 56316Laparoscopy, surgical; repair of initial inguinal herniaherniaGeneral SurgeryHernia Groin – Lap 56317Laparoscopy, surgical; repair of recurrent inguinal herniaherniaGeneral SurgeryHernia Groin – Open49505Repair initial inguinal hernia, age 5 years or over; reducibleHerniaGeneral SurgeryHernia Groin – Open49507Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulatedHerniaGeneral SurgeryHernia Groin – Open49520Repair recurrent inguinal hernia, any age; reducibleHerniaGeneral SurgeryHernia Groin – Open49521Repair recurrent inguinal hernia, any age; incarcerated or strangulatedHerniaGeneral SurgeryHernia Groin – Open49525Repair inguinal hernia, sliding, any ageHerniaGeneral SurgeryHernia Groin – Open49550Repair initial femoral hernia, any age; reducibleHerniaGeneral SurgeryHernia Groin – Open49553Repair initial femoral hernia, any age; incarcerated or strangulatedHerniaGeneral SurgeryHernia Groin – Open49555Repair recurrent femoral hernia; reducibleHerniaGeneral SurgeryHernia Groin – Open49557Repair recurrent femoral hernia; incarcerated or strangulatedHerniaGeneral SurgeryLarge Bowel Other44025Colotomy, for exploration, biopsy(s), or foreign body removalBowelGeneral SurgeryLarge Bowel Other44130Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)BowelGeneral SurgeryLarge Bowel Other44140Colectomy, partial; with anastomosisBowelGeneral SurgeryLarge Bowel Other44145Colectomy, partial; with coloproctostomy (low pelvic anastomosis)BowelGeneral SurgeryLarge Bowel Other44160Colectomy, partial, with removal of terminal ileum with ileocolostomyBowelGeneral SurgeryLarge Bowel Other44205Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomyBowelGeneral SurgeryLarge Bowel Other44320Colostomy or skin level cecostomy;BowelGeneral SurgeryLarge Bowel Other44604Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomyBowelGeneral SurgeryLarge Bowel Other44605Suture of large intestine for perforated ulcer, diverticulu, wound, injury, or rupture; with colostomyBowelGeneral SurgeryLarge Bowel Other44620Closure of enterostomy, large or small intestine;BowelGeneral SurgeryLarge Bowel Other44625Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectalBowelGeneral SurgeryLarge Bowel Other44626Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)BowelGeneral SurgeryLarge Bowel Other45130Excision of rectal procidentia, with anastomosis; perineal approachBowelGeneral SurgeryLarge Bowel Other45135Excision of rectal procidentia, with anastomosis; abdominal and perineal approachBowelGeneral SurgeryLiver Other47010Hepatotomy; for open drainage of abscess or cyst, 1 or 2 stagesHPBGeneral SurgeryLiver Other47015Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or echinococcal) cyst(s) or abscess(es)HPBGeneral SurgeryLiver Other47300Marsupialization of cyst or abscess of liverHPBGeneral SurgeryLiver Other47370Laparoscopy, surgical, ablation of 1 or more liver tumor(s); radiofrequencyHPBGeneral SurgeryLiver Other47371Laparoscopy, surgical, ablation of 1 or more liver tumor(s); cryosurgicalHPBGeneral SurgeryLiver Other47380Ablation, open, of 1 or more liver tumor(s); radiofrequencyHPBGeneral SurgeryLiver Other47381Ablation, open, of one or more liver tumor(s); cryosurgicalHPBGeneral SurgeryLiver Other49200Excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas;HPBGeneral SurgeryLiver Other49201Excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas; extensiveHPBGeneral SurgeryLiver Partial Hepatectomy47100Biopsy of liver, wedgeHPBGeneral SurgeryLiver Partial Hepatectomy47120Hepatectomy, resection of liver; partial lobectomyHPBGeneral SurgeryLiver Partial Hepatectomy47122Hepatectomy, resection of liver; trisegmentectomyHPBGeneral SurgeryLiver Partial Hepatectomy47125Hepatectomy, resection of liver; total left lobectomyHPBGeneral SurgeryLiver Partial Hepatectomy47130Hepatectomy, resection of liver; total right lobectomyHPBGeneral SurgeryLysis of Adhesions44005Enterolysis (freeing of intestinal adhesion) (separate procedure)BowelGeneral SurgeryLysis of Adhesions44180Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)BowelGeneral SurgeryLysis of Adhesions44200Laparoscopy, surgical; enterolysis (freeing of intestinal adhesion) (separate procedure)BowelGeneral SurgeryLysis of Adhesions56304Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)BowelGeneral SurgeryLysis of Adhesions56310Laparoscopy, surgical; enterolysis (freeing of intestinal adhesion) (separate procedure)BowelGeneral SurgeryLysis of Adhesions58660Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure)BowelGeneral SurgeryLysis of Adhesions58740Lysis of adhesions (salpingolysis, ovariolysis)BowelGeneral SurgeryLysis of Adhesions58985Laparoscopy, surgical; with lysis of adhesionsBowelGeneral SurgeryMastectomy19180Mastectomy, simple, completeBreastGeneral SurgeryMastectomy19182Mastectomy, subcutaneousBreastGeneral SurgeryMastectomy19200Mastectomy, radical, including pectoral muscles, axillary lymph nodesBreastGeneral SurgeryMastectomy19220Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (urban type operation)BreastGeneral SurgeryMastectomy19240Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscleBreastGeneral SurgeryMastectomy19303Mastectomy, simpleBreastGeneral SurgeryMastectomy19304Mastectomy, subcutaneousBreastGeneral SurgeryMastectomy19305Mastectomy, radical, including axillary lymph nodesBreastGeneral SurgeryMastectomy19306Mastectomy, radical, including axillary and internal mammary lymph nodesBreastGeneral SurgeryMastectomy19307Mastectomy, modified radicalBreastGeneral SurgeryPancreatectomy48005Resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitisHPBGeneral SurgeryPancreatectomy48105Resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitisHPBGeneral SurgeryPancreatectomy48120Excision of lesion of pancreasHPBGeneral SurgeryPancreatectomy48140Pancreatectomy, distal subtotal, with or without splenectomy; without pancreaticojejunostomyHPBGeneral SurgeryPancreatectomy48145Pancreatectomy, distal subtotal, with or without splenectomy; with pancreaticojejunostomyHPBGeneral SurgeryPancreatectomy48146Pancreatectomy, dista, near-total with preservation of duodenumHPBGeneral SurgeryPancreatectomy48150Pancreatectomy, proximal subtotal (Whipple-type procedure); with pancreatojejunostomyHPBGeneral SurgeryPancreatectomy48152Pancreatectomy, proximal subtotal (Whipple-type procedure); without pancreatojejunostomyHPBGeneral SurgeryPancreatectomy48153Pancreatectomy, proximal subtotal (pylorus-sparing, Whipple-type procedure); with pancreatojejunostomyHPBGeneral SurgeryPancreatectomy48154Pancreatectomy, proximal subtotal (Whipple-type procedure); without pancreatojejunostomyHPBGeneral SurgeryPancreatectomy48155Pancreatectomy, totalHPBGeneral SurgeryPancreatectomy48160Pancreatectomy, total or subtotal, with autologous transplantation of pancreas or pancreatic islet cellsHPBGeneral SurgeryParathyroidectomy60500Parathyroidectomy or exploration of parathyroidsEndocrineGeneral SurgeryParathyroidectomy60502Parathyroidectomy or exploration of parathyroids; reexplorationEndocrineGeneral SurgeryParathyroidectomy60505Parathyroidectomy or exploration of parathyroids; with mediastinal exploration, sternal split or transthoracic approachEndocrineGeneral SurgeryPD Access Procedure49324Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheterBowelGeneral SurgeryPD Access Procedure49419Insertion of tunneled intraperitoneal catheter, with subcutaneous portBowelGeneral SurgeryPD Access Procedure49420Insertion of intraperitoneal cannula or catheter for drainage or dialysis; temporaryBowelGeneral SurgeryPD Access Procedure49421Insertion of tunneled intraperitoneal catheter for dialysis, openBowelGeneral SurgeryProctectomy44143Colectomy, partial; with end colostomy and closure of distal segment (Hartmann type procedure)BowelGeneral SurgeryProctectomy44145Colectomy, partial; with coloproctostomy (low pelvic anastomosis)BowelGeneral SurgeryProctectomy44146Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomyBowelGeneral SurgeryProctectomy44147Colectomy, partial; abdominal and transanal approachBowelGeneral SurgeryProctectomy44155Colectomy, total, abdominal, with proctectomy; with ileostomyBowelGeneral SurgeryProctectomy44207Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)BowelGeneral SurgeryProctectomy45110Proctectomy; complete, combined abdominoperineal, with colostomyBowelGeneral SurgeryProctectomy45111Proctectomy; partial resection of rectum, transabdominal approachBowelGeneral SurgeryProctectomy45112Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal anastomosis)BowelGeneral SurgeryProctectomy45113Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop ileostomyBowelGeneral SurgeryProctectomy45119Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy when performedBowelGeneral SurgeryProctectomy45120Proctectomy, complete, abdominal and perineal approach; with pull-through procedure and anastomosisBowelGeneral SurgeryProctectomy45121Proctectomy, complete, abdominal and perineal approach; with subtotal or total colectomyBowelGeneral SurgeryProctectomy45123Proctectomy, partial, without anastomosis, perineal approachBowelGeneral SurgeryProctectomy45130Excision of rectal procidentia, with anastomosis; perineal approachBowelGeneral SurgeryProctectomy45395Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomyBowelGeneral SurgeryProctectomy45397Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure, with colonic reservoirBowelGeneral SurgeryProctopexy45400Laparoscopy, surgical; proctopexy (for prolapse)BowelGeneral SurgeryProctopexy45402Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resectionBowelGeneral SurgeryProctopexy45505Proctoplasty; for prolapse of mucous membraneBowelGeneral SurgeryProctopexy45540Proctopexy (eg, for prolapse); abdominal approachBowelGeneral SurgeryProctopexy45541Proctopexy (eg, for prolapse); perineal approachBowelGeneral SurgeryProctopexy45550Proctopexy with sigmoid resection, abdominal approachBowelGeneral SurgeryPyloroplasty43640Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selectiveBowelGeneral SurgeryPyloroplasty43641Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective)BowelGeneral SurgeryPyloroplasty43800PyloroplastyBowelGeneral SurgerySmall Bowel Other44020Enterotomy, small intestine, other than duodenum; for exploration, biopsy(s), or foreign body removalBowelGeneral SurgerySmall Bowel Other44021Enterotomy, small intestine, other than duodenum; for decompression (eg, Baker tube)BowelGeneral SurgerySmall Bowel Other44120Entrectomy, resection of small intestine; single resection and anastomosisBowelGeneral SurgerySmall Bowel Other44125Enterectomy, resection of small intestine; with enterostomyBowelGeneral SurgerySmall Bowel Other44130Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)BowelGeneral SurgerySmall Bowel Other44602Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforationBowelGeneral SurgerySmall Bowel Other44603Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforationsBowelGeneral SurgerySmall Bowel Other44615Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation, for intestinal obstructionBowelGeneral SurgerySmall Bowel Other44620Closure of enterostomy, large or small intestine;BowelGeneral SurgerySmall Bowel Other44625Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectalBowelGeneral SurgerySmall Bowel Other44626Closure of enterostomy, large or small intestine; with resection and colorectal anastomosis (eg, closure of Hartmann type procedure)BowelGeneral SurgerySmall Bowel Other44640Closure of intestinal cutaneous fistulaBowelGeneral SurgerySmall Bowel Other44661Closure of enterovesical fistula; with intestine and/or bladder resectionBowelGeneral SurgerySmall Bowel Other45136Excision of ileoanal reservoir with ileostomyBowelGeneral SurgerySmall Bowel Resection44120Enterectomy, resection of small intestine; single resection and anastomosisBowelGeneral SurgerySmall Bowel Resection44125Enterectomy, resection of small intestine; with enterostomyBowelGeneral SurgerySmall Bowel Resection44130Enteroenterostomy, anastomosis of intestine, with or without cutaneous enterostomy (separate procedure)BowelGeneral SurgerySmall Bowel Resection44202Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosisBowelGeneral SurgerySmall Bowel Resection44314Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)BowelGeneral SurgerySmall Bowel Resection44620Closure of enterostomy, large or small intestine;BowelGeneral SurgerySmall Bowel Resection44625Closure of enterostomy, large or small intestine; with resection and anastomosis other than colorectalBowelGeneral SurgerySmall Bowel Resection56348Laparoscopy, surgical; intestinal resection, with anastomosis (intra or extracorporeal)BowelGeneral SurgerySplenectomy38100Splenectomy; total (separate procedure)HPBGeneral SurgerySplenectomy38120Laparoscopy, surgical, splenectomyHPBGeneral SurgerySplenectomy56345Laparoscopy, surgical; splenectomyHPBGeneral SurgeryStomach Anti-Reflux43280Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)UGIGeneral SurgeryStomach Anti-Reflux43324Esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill procedures)UGIGeneral SurgeryStomach Anti-Reflux43325Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)UGIGeneral SurgeryStomach Anti-Reflux43326Esophagogastric fundoplasty; with gastroplasty (eg, Collis)UGIGeneral SurgeryStomach Anti-Reflux56349Laparoscopy, surgical; esophagogastric fundoplasty (eg, Nissen, Belsey IV, Hill, Toupet procedures)UGIGeneral SurgeryStomach Gastric Bypass (non-bariatric)43810GastroduodenostomyUGIGeneral SurgeryStomach Gastric Bypass (non-bariatric)43820Gastrojejunostomy; without vagotomyUGIGeneral SurgeryStomach Gastric Bypass (non-bariatric)43825Gastrojejunostomy; with vagotomy, any typeUGIGeneral SurgeryStomach Gastric Bypass (non-bariatric)43860Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomyUGIGeneral SurgeryStomach Other43500Gastrotomy; with exploration or foreign body removalUGIGeneral SurgeryStomach Other43605Biopsy of stomach; by laparotomyUGIGeneral SurgeryStomach Other43610Excision, local; ulcer or benign tumor of stomachUGIGeneral SurgeryStomach Other43611Excision, local; malignant tumor of stomachUGIGeneral SurgeryStomach Other43840Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injuryUGIGeneral SurgeryStomach Other43870Closure of gastrostomy, surgicalUGIGeneral SurgeryStomach Partial Gastrectomy43630Hemigastrectomy or distal subtotal gastrectomy including pyloroplasty, gastroduodenostomy or gastrojejunostomy; without vagotomyUGIGeneral SurgeryStomach Partial Gastrectomy43631Gastrectomy, partial, distal; with gastroduodenostomyUGIGeneral SurgeryStomach Partial Gastrectomy43632Gastrectomy, partial, distal; with gastrojejunostomyUGIGeneral SurgeryStomach Partial Gastrectomy43633Gastrectomy, partial, distal; with Roux-en-Y reconstructionUGIGeneral SurgeryStomach Partial Gastrectomy43634Gastrectomy, partial, distal; with formation of intestinal pouchUGIGeneral SurgeryStomach Partial Gastrectomy43638Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy;UGIGeneral SurgeryStomach Partial Gastrectomy43639Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy; with pyloroplasty or pyloromyotomyUGIGeneral SurgeryStomach Total Gastrectomy43620Gastrectomy, total; with esophagoenterostomyUGIGeneral SurgeryStomach Total Gastrectomy43621Gastrectomy, total; with Roux-en-Y reconstructionUGIGeneral SurgeryStomach Total Gastrectomy43622Gastrectomy, total; with formation of intestinal pouch, any typeUGIGeneral SurgeryStomach Total Gastrectomy43625Gastrectomy, total; with repair by intestinal transplantUGIGeneral SurgeryThyroidectomy Partial60200Excision of cyst or adenoma of thyroid, or transection of isthmusEndocrineGeneral SurgeryThyroidectomy Partial60210Partial thyroid lobectomy, unilateral; with or without isthmusectomyEndocrineGeneral SurgeryThyroidectomy Partial60212Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomyEndocrineGeneral SurgeryThyroidectomy Partial60220Total thyroid lobectomy, unilateral; with or without isthmusectomyEndocrineGeneral SurgeryThyroidectomy Partial60225Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomyEndocrineGeneral SurgeryThyroidectomy Partial60245Thyroidectomy, subtotal or partialEndocrineGeneral SurgeryThyroidectomy Partial60246Thyroidectomy, subtotal or partial; with removal of substernal thyroid gland, cervical approachEndocrineGeneral SurgeryThyroidectomy Substernal60270Thyroidectomy, including substernal thyroid; sternal split or transthoracic approachEndocrineGeneral SurgeryThyroidectomy Substernal60271Thyroidectomy, including substernal thyroid; cervical approachEndocrineGeneral SurgeryThyroidectomy Total60225Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomyEndocrineGeneral SurgeryThyroidectomy Total60240Thyroidectomy, total or completeEndocrineGeneral SurgeryThyroidectomy Total60252Thyroidectomy, total or subtotal for malignancy; with limited neck dissectionEndocrineGeneral SurgeryThyroidectomy Total60254Thyroidectomy, total or subtotal for malignancy; with radical neck dissectionEndocrineGeneral SurgeryThyroidectomy Total60260Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroidEndocrineGeneral SurgeryThyroidectomy Total60270Thyroidectomy, including substernal thyroid; sternal split or transthoracic approachEndocrineGeneral SurgeryThyroidectomy Total60271Thyroidectomy, including substernal thyroid; cervical approachEndocrineGeneral SurgeryUlcer43501Gastrotomy; with suture repair of bleeding ulcerBowelGeneral SurgeryUlcer43502Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)BowelGeneral SurgeryUlcer43640Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selectiveBowelGeneral SurgeryUlcer43840Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injuryBowelGeneral SurgeryUlcer44010Duodenotomy, for exploration, biopsy(s), or foreign body removalBowelGeneral SurgeryUlcer44600Suture of intestine (enterorrhaphy), large or small, for perforated ulcer, diverticulum, wound, injury or rupture; singleBowelGeneral SurgeryUlcer44602Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforationBowelGeneral SurgeryUlcer44603Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforationsBowelGeneral SurgeryUlcer44610Suture of intestine (enterorrhaphy), large or small, for perforated ulcer, diverticulum, wound, injury or rupture; multipleBowelOrthopedic SurgeryHip Repair27122Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)OrthoOrthopedic SurgeryHip Repair27125Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)OrthoOrthopedic SurgeryHip Repair27234Treatment of open femoral fracture, proximal end, neck, with uncomplicated soft tissue closure, with manipulation (including skeletal traction)OrthoOrthopedic SurgeryHip Repair27236Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacementOrthoOrthopedic SurgeryHip Repair27242Treatment of open intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture, with uncomplicated soft tissue closure (including traction)OrthoOrthopedic SurgeryHip Repair27244Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclageOrthoOrthopedic SurgeryHip Repair27245Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclageOrthoOrthopedic SurgeryHip Repair27248Open treatment of greater trochanteric fracture, includes internal fixation, when performedOrthoOrthopedic SurgeryHip Repair27269Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performedOrthoOrthopedic SurgeryHip Repair27506Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screwsOrthoOrthopedic SurgeryHip Repair27507Open treatment of femoral shaft fracture with plate/screws, with or without cerclageOrthoOrthopedic SurgeryHip Replacement27125Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)OrthoOrthopedic SurgeryHip Replacement27126Partial hip replacement (hemiarthroplasty); cupOrthoOrthopedic SurgeryHip Replacement27130Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograftOrthoOrthopedic SurgeryHip Replacement27132Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograftOrthoOrthopedic SurgeryHip Replacement27236Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacementOrthoOrthopedic SurgeryHip Replacement Revision27091Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacerOrthoOrthopedic SurgeryHip Replacement Revision27132Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograftOrthoOrthopedic SurgeryHip Replacement Revision27134Revision of total hip arthroplasty; both components, with or without autograft or allograftOrthoOrthopedic SurgeryHip Replacement Revision27137Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograftOrthoOrthopedic SurgeryHip Replacement Revision27138Revision of total hip arthroplasty; femoral component only, with or without allograftOrthoOrthopedic SurgeryKnee Replacement27440Arthroplasty, knee, tibial plateau;OrthoOrthopedic SurgeryKnee Replacement27441Arthroplasty, knee, tibial plateau; with debridement and partial synovectomyOrthoOrthopedic SurgeryKnee Replacement27442Arthroplasty, femoral condyles or tibial plateau(s), knee;OrthoOrthopedic SurgeryKnee Replacement27443Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomyOrthoOrthopedic SurgeryKnee Replacement27445Arthroplasty, knee, hinge prosthesis (eg, Walldius type)OrthoOrthopedic SurgeryKnee Replacement27446Arthroplasty, knee, condyle and plateau; medial OR lateral compartmentOrthoOrthopedic SurgeryKnee Replacement27447Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)OrthoOrthopedic SurgeryKnee Replacement Revision27486Revision of total knee arthroplasty, with or without allograft; 1 componentOrthoOrthopedic SurgeryKnee Replacement Revision27487Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial componentOrthoOrthopedic SurgeryKnee Replacement Revision27488Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, kneeOrthoeTable seq NumList 3. Patient Selection Summary.Adnissmions RetainedSurgeons RetainedPatientsRetainedHosps RetainedExclusion StepOverallNewSurgeonsExp.SurgeonsNewTrad. Exp.Trad. NewMod. Exp. Mod. N (%)N (%)N (%)NNNNN (%)N (%)All admissions of any kind.18,976,162------------------6,708,45311,710Retain only admissions with qualifying ICD-9 Principal Procedure.8,018,173(100.0%)------------------6,701,612(100.0%)7,224(100.0%)Exclude admissions before July 1, 1999 or after June 30, 2003 in the traditional era, or admissions before July 1, 2009 or after June 30, 2013 in the modern era.7,855,914(98.0%)------------------6,675,239(99.6%)7,170(99.3%)Exclude admissions if patient could not be found in the Master Beneficiary Summary File, or had missing date of birth or sex in the MBSF.7,855,914(98.0%)------------------6,675,239(99.6%)7,170(99.3%)Exclude admissions with patients who were under age 65.5 at admission.6,783,537(84.6%)------------------5,790,906(86.4%)6,919(95.8%)Exclude admissions outside the 50 states or District of Columbia.6,741,188(84.1%)------------------5,752,970(85.8%)6,908(95.6%)Exclude admissions with discharge status: still patient.6,737,544(84.0%)------------------5,751,392(85.8%)6,889(95.4%)Exclude admissions with Medicare status: End-Stage Renal Disease.6,737,544(84.0%)------------------5,751,392(85.8%)6,889(95.4%)Exclude admissions that were not in short-term acute-care hospitals.6,651,517(83.0%)------------------5,683,631(84.8%)4,859(67.3%)Exclude admissions if the patient was in HMO or lacked Part B in the month of admission, the month following, or the 6 months prior to admission.6,347,234(79.2%)------------------5,424,298(80.9%)4,853(67.2%)Exclude admissions without Part B CPT operation of interest. 5,856,554(73.0%)------------------5,052,084(75.4%)4,810(66.6%)Exclude admissions whose surgeons were neither new nor experienced in the AMA file.4,695,852(58.6%)739,008(--)4,574,836(--)4,67626,9734,20130,4144,108,493(61.3%)4,667(64.6%)Exclude admissions for new surgeons too far removed from their YOT, or YOG, or for experienced surgeons too close to their YOT, or YOG.4,290,363(53.5%)529,001(100.0%)4,188,932(100.0%)4,61026,4934,13129,8513,778,215(56.4%)4,643(64.3%)Exclude admissions from a surgeon's minority specialty practice (Gensurg or Orthopedic).4,286,895(53.5%)528,940(100.0%)4,185,470(99.9%)4,61026,4934,13129,8513,775,237(56.3%)4,643(64.3%)Exclude admissions if a patient saw a surgeon at their non-majority hospital.3,724,626(46.5%)453,287(85.7%)3,637,492(86.8%)4,61026,4934,13129,8513,304,476(49.3%)4,070(56.3%)Randomly sample 1 admission per patient.3,304,476(41.2%)407,481(77.0%)3,225,741(77.0%)4,59026,3774,10129,7003,304,476(49.3%)4,069(56.3%)Exclude admissions from surgeons that did not have at least 10 cases.3,234,282(40.3%)385,134(72.8%)3,163,281 (75.5%)2,94119,6742,20620,9543,234,282(48.3%)3,741(51.8%)Exclude admissions from hospitals that did not have at least 1 new surgeon and at least 1 experienced surgeon.1,598,754(19.9%)258,754(48.9%)1,530,718(36.5%)2,7629,2972,1198,5031,598,754(23.9%)1,902(26.3%)Note. Based on the definitions of training era and experience level, there were 10,496 Traditional New; 47,078 Traditional Experienced; 9,138 Modern New; and 71,723 Modern Experienced general and orthopedic surgeons identified in the AMA Masterfile. eTable seq NumList 4. Risk Models for 30-day Mortality. All risk models were estimated using the patients of surgeons who were eligible for study inclusion but whose surgeons did not pair in the surgeon level match. In addition to overall risk models, risk models based only on patient comorbidities were estimated in order to help balance these variables in the patient level matches. REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic a. General Surgery Traditional Era (1999-2003) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.04 (0.05)Age 65-69 (Reference)--?--?--?--?Age 70-740.23 (0.04)1.26 (1.26, 1.36)6.0<.0001Age 75-790.43 (0.04)1.53 (1.53, 1.65)11.5<.0001Age 80-840.74 (0.04)2.09 (2.09, 2.25)19.6<.0001Age 85+1.23 (0.04)3.41 (3.41, 3.68)32.6<.0001Sex (female)-0.07 (0.02)0.93 (0.93, 0.97)-3.30.0011Emergent Admission0.63 (0.02)1.89 (1.89, 1.97)29.9<.0001Transfer-in0.65 (0.04)1.91 (1.91, 2.07)15.7<.0001Past Admission in Last 6 Months0.12 (0.02)1.13 (1.13, 1.18)5.3<.0001Principal Procedure Categories????Adrenalectomy-0.91 (0.39)0.40 (0.40, 0.88)-2.30.0217Appendectomy-1.00 (0.09)0.37 (0.37, 0.44)-10.8<.0001Bariatric-0.12 (0.46)0.88 (0.88, 2.19)-0.30.7883Biliary common duct-0.95 (0.40)0.39 (0.39, 0.84)-2.40.0165Biliary other-0.28 (0.10)0.76 (0.76, 0.93)-2.60.0083Cholecystectomy-0.95 (0.03)0.39 (0.39, 0.41)-28.7<.0001Colectomy Partial – Open (Reference)--?--?--?--?Colectomy Total - Open0.64 (0.06)1.90 (1.90, 2.16)10.0<.0001Esophagectomy or Esophagomyotomy-0.09 (0.15)0.91 (0.91, 1.22)-0.60.5297Hernia Abdominal – Open -1.13 (0.07)0.32 (0.32, 0.37)-15.8<.0001Hernia Groin – Open-1.32 (0.07)0.27 (0.27, 0.31)-18.3<.0001Large Bowel Other0.30 (0.08)1.35 (1.35, 1.59)3.60.0003Liver Procedures-0.81 (0.26)0.44 (0.44, 0.73)-3.20.0016Lysis of Adhesions-0.16 (0.05)0.85 (0.85, 0.93)-3.50.0004Mastectomy-1.88 (0.10)0.15 (0.15, 0.19)-18.3<.0001Pancreatectomy-0.50 (0.10)0.61 (0.61, 0.74)-5.0<.0001Parathyroidectomy-2.12 (0.21)0.12 (0.12, 0.18)-10.0<.0001PD Access Procedure-0.90 (0.10)0.41 (0.41, 0.50)-8.7<.0001Proctectomy-0.48 (0.06)0.62 (0.62, 0.70)-7.8<.0001Proctopexy-0.80 (0.46)0.45 (0.45, 1.10)-1.70.0802Pyloroplasty0.28 (0.15)1.32 (1.32, 1.78)1.80.0677Small Bowel Other0.18 (0.09)1.20 (1.20, 1.44)2.00.0461Small Bowel Resection0.30 (0.04)1.35 (1.35, 1.45)8.5<.0001Splenectomy0.29 (0.09)1.33 (1.33, 1.58)3.30.0011Stomach Anti-Reflux-1.19 (0.19)0.30 (0.30, 0.44)-6.4<.0001Stomach Gastric Bypass (non-bariatric)0.78 (0.09)2.18 (2.18, 2.59)8.9<.0001Stomach Other0.37 (0.13)1.45 (1.45, 1.88)2.80.0045Stomach Partial Gastrectomy0.40 (0.06)1.48 (1.48, 1.67)6.5<.0001Stomach Total Gastrectomy0.70 (0.10)2.02 (2.02, 2.48)6.8<.0001Thyroidectomy Partial-1.53 (0.23)0.22 (0.22, 0.34)-6.6<.0001Thyroidectomy Substernal-0.91 (0.51)0.40 (0.40, 1.10)-1.80.0763Thyroidectomy Total-2.12 (0.38)0.12 (0.12, 0.25)-5.5<.0001Ulcer0.87 (0.05)2.39 (2.39, 2.66)15.8<.0001Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.38 (0.02)1.46 (1.46, 1.53)17.0<.0001Comorbidities????Congestive Heart Failure0.54 (0.02)1.71 (1.71, 1.79)23.2<.0001Past Myocardial Infarction-0.01 (0.03)0.99 (0.99, 1.05)-0.40.7030Past Arrhythmia0.04 (0.02)1.04 (1.04, 1.09)1.90.0615Angina-0.22 (0.04)0.80 (0.80, 0.86)-6.1<.0001Valvular Disease0.13 (0.02)1.13 (1.13, 1.19)5.4<.0001Unstable Angina-0.13 (0.05)0.88 (0.88, 0.97)-2.70.0070Hypertension-0.26 (0.02)0.77 (0.77, 0.80)-11.6<.0001Diabetes0.01 (0.02)1.01 (1.01, 1.05)0.30.7853Renal Dysfunction1.45 (0.03)4.28 (4.28, 4.51)54.8<.0001Renal Failure0.06 (0.04)1.06 (1.06, 1.13)1.50.1276Liver Disease0.35 (0.03)1.42 (1.42, 1.51)11.8<.0001Cancer-0.08 (0.02)0.93 (0.93, 0.97)-3.30.0009Specific Abdominal Cancer0.68 (0.04)1.98 (1.98, 2.16)15.7<.0001Dementia0.41 (0.03)1.50 (1.50, 1.58)14.7<.0001Stroke0.09 (0.03)1.10 (1.10, 1.17)2.80.0053Seizure0.27 (0.08)1.31 (1.31, 1.53)3.30.0011Paraplegia0.23 (0.06)1.26 (1.26, 1.41)4.00.0001COPD0.38 (0.02)1.46 (1.46, 1.52)17.5<.0001Asthma-0.08 (0.04)0.93 (0.93, 1.00)-2.00.0421Post-inflammatory Pulmonary Fibrosis0.13 (0.05)1.14 (1.14, 1.25)2.90.0035Hypothyroidism-0.08 (0.03)0.92 (0.92, 0.97)-3.00.0027Thrombocytopenia0.26 (0.06)1.30 (1.30, 1.46)4.3<.0001Collagen Vascular Disease0.09 (0.04)1.10 (1.10, 1.19)2.20.0289Chronic Peptic Ulcer-0.33 (0.13)0.72 (0.72, 0.93)-2.50.0116Coagulopathy-0.01 (0.14)0.99 (0.99, 1.30)-0.10.9551Other Coagulopathy0.52 (0.04)1.68 (1.68, 1.80)14.9<.0001Cushing’s Disease0.05 (0.33)1.05 (1.05, 2.01)0.10.8836Graves’ Disease-0.16 (0.21)0.85 (0.85, 1.28)-0.80.4372Hemoglobin Disorder0.29 (0.39)1.34 (1.34, 2.86)0.80.4496Summary StatisticsNumber of Observations228,762Number of Deaths12,788C-statistic0.842 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic b. General Surgery Traditional Era (1999-2003) Risk Model (Comorbidities Only).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-3.56 (0.02)Congestive Heart Failure0.74 (0.02)2.09 (2.09, 2.18)32.9<.0001Past Myocardial Infarction-0.06 (0.03)0.94 (0.94, 1.00)-2.10.0381Past Arrhythmia0.09 (0.02)1.09 (1.09, 1.14)4.00.0001Angina-0.23 (0.04)0.79 (0.79, 0.85)-6.5<.0001Valvular Disease0.22 (0.02)1.25 (1.25, 1.30)9.8<.0001Unstable Angina-0.13 (0.05)0.88 (0.88, 0.96)-2.80.0049Hypertension-0.24 (0.02)0.79 (0.79, 0.82)-11.0<.0001Diabetes-0.11 (0.02)0.90 (0.90, 0.94)-5.0<.0001Renal Dysfunction1.69 (0.03)5.42 (5.42, 5.70)65.6<.0001Renal Failure-0.19 (0.03)0.82 (0.82, 0.88)-5.6<.0001Liver Disease0.24 (0.03)1.27 (1.27, 1.34)8.4<.0001Cancer0.03 (0.02)1.03 (1.03, 1.07)1.60.1050Specific Abdominal Cancer0.77 (0.04)2.16 (2.16, 2.32)20.8<.0001Dementia0.78 (0.03)2.18 (2.18, 2.29)29.8<.0001Stroke0.10 (0.03)1.11 (1.11, 1.18)3.30.0011Seizure0.30 (0.08)1.36 (1.36, 1.58)3.90.0001Paraplegia0.26 (0.06)1.30 (1.30, 1.44)4.7<.0001COPD0.46 (0.02)1.58 (1.58, 1.65)22.3<.0001Asthma-0.14 (0.04)0.87 (0.87, 0.93)-4.00.0001Post-inflammatory Pulmonary Fibrosis0.20 (0.04)1.22 (1.22, 1.33)4.5<.0001Hypothyroidism-0.09 (0.03)0.91 (0.91, 0.96)-3.70.0002Thrombocytopenia0.32 (0.06)1.37 (1.37, 1.53)5.7<.0001Collagen Vascular Disease0.14 (0.04)1.16 (1.16, 1.25)3.50.0004Chronic Peptic Ulcer0.21 (0.13)1.23 (1.23, 1.57)1.60.1044Coagulopathy0.05 (0.13)1.05 (1.05, 1.36)0.40.6864Other Coagulopathy0.58 (0.03)1.79 (1.79, 1.92)17.4<.0001Cushing’s Disease-0.01 (0.31)0.99 (0.99, 1.81)0.00.9652Graves’ Disease-0.62 (0.20)0.54 (0.54, 0.79)-3.10.0018Hemoglobin Disorder0.38 (0.37)1.47 (1.47, 3.05)1.00.3046Summary StatisticsNumber of Observations228,762Number of Deaths12,788C-statistic0.764 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic c. Orthopedics Traditional Era (1999-2003) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-5.93 (0.15)Age 65-69 (Reference)--?--?--?--?Age 70-740.32 (0.07)1.38 (1.38, 1.58)4.6<.0001Age 75-790.61 (0.07)1.84 (1.84, 2.09)9.3<.0001Age 80-840.89 (0.06)2.45 (2.45, 2.77)14.0<.0001Age 85+1.47 (0.06)4.35 (4.35, 4.92)23.4<.0001Sex (Female)-0.54 (0.02)0.58 (0.58, 0.61)-23.0<.0001Emergent Admission0.45 (0.03)1.57 (1.57, 1.65)18.0<.0001Transfer-in0.35 (0.07)1.41 (1.41, 1.62)5.0<.0001Past Admission in Last 6 Months0.01 (0.03)1.01 (1.01, 1.06)0.40.7081Principal Procedure Categories????Hip Repair1.61 (0.14)5.00 (5.00, 6.56)11.6<.0001Hip Replacement1.41 (0.14)4.09 (4.09, 5.36)10.2<.0001Hip Replacement Revision0.68 (0.16)1.98 (1.98, 2.70)4.4<.0001Knee Replacement0.01 (0.14)1.01 (1.01, 1.33)0.10.9597Knee Replacement Revision (Reference)--?--?--?--?Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.44 (0.04)1.56 (1.56, 1.69)10.4<.0001Comorbidities????Congestive Heart Failure0.64 (0.02)1.90 (1.90, 2.00)26.4<.0001Past Myocardial Infarction0.06 (0.04)1.06 (1.06, 1.14)1.60.1061Past Arrhythmia0.03 (0.03)1.03 (1.03, 1.08)1.10.2690Angina-0.06 (0.04)0.94 (0.94, 1.02)-1.40.1514Valvular Disease0.23 (0.03)1.26 (1.26, 1.33)9.1<.0001Unstable Angina-0.04 (0.06)0.96 (0.96, 1.09)-0.70.5129Hypertension-0.26 (0.02)0.77 (0.77, 0.81)-10.9<.0001Diabetes0.07 (0.03)1.08 (1.08, 1.13)2.80.0052Renal Dysfunction0.97 (0.04)2.65 (2.65, 2.85)26.4<.0001Renal Failure0.22 (0.05)1.24 (1.24, 1.36)4.7<.0001Liver Disease0.33 (0.06)1.39 (1.39, 1.55)5.8<.0001Cancer0.09 (0.03)1.10 (1.10, 1.15)3.60.0003Specific Abdominal Cancer0.59 (0.14)1.80 (1.80, 2.37)4.2<.0001Dementia0.73 (0.02)2.07 (2.07, 2.16)31.2<.0001Stroke0.04 (0.03)1.04 (1.04, 1.10)1.10.2613Seizure0.02 (0.08)1.02 (1.02, 1.20)0.30.7909Paraplegia-0.06 (0.06)0.94 (0.94, 1.06)-1.00.3326COPD0.49 (0.02)1.63 (1.63, 1.71)20.9<.0001Asthma-0.27 (0.05)0.77 (0.77, 0.84)-5.6<.0001Post-inflammatory Pulmonary Fibrosis0.40 (0.05)1.49 (1.49, 1.63)8.9<.0001Hypothyroidism-0.17 (0.03)0.84 (0.84, 0.89)-6.2<.0001Thrombocytopenia0.19 (0.08)1.20 (1.20, 1.41)2.30.0213Collagen Vascular Disease-0.15 (0.05)0.86 (0.86, 0.95)-3.00.0025Chronic Peptic Ulcer0.06 (0.30)1.06 (1.06, 1.92)0.20.8481Coagulopathy0.22 (0.16)1.24 (1.24, 1.70)1.30.1785Other Coagulopathy0.10 (0.05)1.10 (1.10, 1.21)2.10.0357Cushing’s Disease0.11 (0.44)1.11 (1.11, 2.61)0.20.8055Graves’ Disease-0.20 (0.25)0.82 (0.82, 1.33)-0.80.4197Hemoglobin Disorder1.24 (0.47)3.47 (3.47, 8.65)2.70.0077Summary StatisticsNumber of Observations322,889Number of Deaths10,034C-statistic0.853 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic d. Orthopedics Traditional Era (1999-2003) Risk Model (Comorbidities Only).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.18 (0.02)Congestive Heart Failure0.93 (0.02)2.53 (2.53, 2.66)38.4<.0001Past Myocardial Infarction0.06 (0.04)1.06 (1.06, 1.14)1.70.0900Past Arrhythmia0.07 (0.02)1.07 (1.07, 1.12)2.60.0084Angina-0.05 (0.04)0.95 (0.95, 1.03)-1.10.2519Valvular Disease0.33 (0.03)1.38 (1.38, 1.45)12.8<.0001Unstable Angina-0.06 (0.06)0.94 (0.94, 1.07)-0.90.3446Hypertension-0.37 (0.02)0.69 (0.69, 0.73)-15.7<.0001Diabetes-0.03 (0.03)0.97 (0.97, 1.02)-1.30.2035Renal Dysfunction1.09 (0.04)2.98 (2.98, 3.20)29.7<.0001Renal Failure0.26 (0.05)1.30 (1.30, 1.42)5.7<.0001Liver Disease0.24 (0.06)1.27 (1.27, 1.42)4.3<.0001Cancer0.21 (0.02)1.23 (1.23, 1.30)8.4<.0001Specific Abdominal Cancer0.71 (0.14)2.04 (2.04, 2.68)5.1<.0001Dementia1.40 (0.02)4.07 (4.07, 4.25)63.7<.0001Stroke0.12 (0.03)1.13 (1.13, 1.20)4.00.0001Seizure-0.01 (0.08)0.99 (0.99, 1.16)-0.10.8905Paraplegia-0.02 (0.06)0.98 (0.98, 1.11)-0.30.7938COPD0.60 (0.02)1.82 (1.82, 1.90)26.2<.0001Asthma-0.46 (0.05)0.63 (0.63, 0.70)-9.7<.0001Post-inflammatory Pulmonary Fibrosis0.49 (0.04)1.63 (1.63, 1.78)11.0<.0001Hypothyroidism-0.22 (0.03)0.80 (0.80, 0.85)-7.9<.0001Thrombocytopenia0.25 (0.08)1.28 (1.28, 1.50)3.10.0020Collagen Vascular Disease-0.38 (0.05)0.68 (0.68, 0.75)-7.8<.0001Chronic Peptic Ulcer0.07 (0.30)1.07 (1.07, 1.93)0.20.8138Coagulopathy0.18 (0.16)1.19 (1.19, 1.63)1.10.2653Other Coagulopathy0.06 (0.05)1.06 (1.06, 1.16)1.30.1905Cushing’s Disease-0.08 (0.43)0.92 (0.92, 2.16)-0.20.8527Graves’ Disease-0.33 (0.25)0.72 (0.72, 1.16)-1.40.1758Hemoglobin Disorder0.94 (0.45)2.56 (2.56, 6.24)2.10.0388Summary StatisticsNumber of Observations322,889Number of Deaths10,034C-statistic0.798 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic e. General Surgery Modern Era (2009-9/29/2010) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.03 (0.11)Age 65-69 (Reference)--?--?--?--?Age 70-740.19 (0.08)1.21 (1.21, 1.41)2.40.0160Age 75-790.48 (0.08)1.61 (1.61, 1.87)6.2<.0001Age 80-840.66 (0.08)1.94 (1.94, 2.25)8.6<.0001Age 85+1.12 (0.08)3.06 (3.06, 3.56)14.7<.0001Sex (female)-0.12 (0.04)0.89 (0.89, 0.97)-2.60.0090Emergent Admission0.66 (0.05)1.93 (1.93, 2.12)13.7<.0001Transfer-in0.54 (0.09)1.72 (1.72, 2.05)6.0<.0001Past Admission in Last 6 Months0.14 (0.05)1.15 (1.15, 1.26)2.90.0039Principal Procedure CategoriesAppendectomy-1.50 (0.19)0.22 (0.22, 0.32)-8.0<.0001Bariatric-1.86 (0.58)0.16 (0.16, 0.49)-3.20.0014Biliary common duct-0.54 (0.64)0.58 (0.58, 2.03)-0.80.3963Biliary other-0.73 (0.29)0.48 (0.48, 0.84)-2.60.0107Cholecystectomy-1.36 (0.08)0.26 (0.26, 0.30)-18.0<.0001Colectomy Partial - Lap-1.25 (0.13)0.29 (0.29, 0.37)-9.5<.0001Colectomy Partial – Open (Reference)--?--?--?--?Colectomy Total - Lap-0.54 (0.75)0.58 (0.58, 2.54)-0.70.4697Colectomy Total - Open0.38 (0.13)1.46 (1.46, 1.87)2.90.0036Esophagectomy or Esophagomyotomy-0.26 (0.26)0.77 (0.77, 1.29)-1.00.3225Hernia Abdominal – Lap-1.49 (0.42)0.22 (0.22, 0.51)-3.60.0004Hernia Abdominal – Open -1.16 (0.15)0.31 (0.31, 0.42)-7.7<.0001Hernia Groin – Lap -2.64 (1.01)0.07 (0.07, 0.52)-2.60.0089Hernia Groin – Open-1.36 (0.16)0.26 (0.26, 0.35)-8.7<.0001Large Bowel Other-0.49 (0.21)0.61 (0.61, 0.93)-2.30.0215Liver Partial Hepatectomy-0.51 (0.20)0.60 (0.60, 0.89)-2.50.0119Lysis of Adhesions-0.47 (0.09)0.63 (0.63, 0.75)-5.0<.0001Mastectomy-1.84 (0.29)0.16 (0.16, 0.28)-6.5<.0001Pancreatectomy-0.74 (0.17)0.48 (0.48, 0.67)-4.3<.0001Parathyroidectomy-1.68 (0.34)0.19 (0.19, 0.37)-4.9<.0001PD Access Procedure-1.10 (0.27)0.33 (0.33, 0.56)-4.1<.0001Proctectomy-0.73 (0.16)0.48 (0.48, 0.65)-4.7<.0001Pyloroplasty0.35 (0.35)1.42 (1.42, 2.81)1.00.3117Small Bowel Other-0.06 (0.17)0.94 (0.94, 1.32)-0.40.7149Small Bowel Resection0.02 (0.07)1.02 (1.02, 1.16)0.20.8082Splenectomy0.26 (0.18)1.29 (1.29, 1.84)1.40.1616Stomach Anti-Reflux-1.31 (0.42)0.27 (0.27, 0.61)-3.20.0016Stomach Gastric Bypass (non-bariatric)0.64 (0.19)1.90 (1.90, 2.76)3.40.0008Stomach Other0.47 (0.26)1.60 (1.60, 2.66)1.80.0656Stomach Partial Gastrectomy-0.21 (0.15)0.81 (0.81, 1.09)-1.40.1707Stomach Total Gastrectomy0.33 (0.24)1.39 (1.39, 2.23)1.30.1779Thyroidectomy Partial-1.94 (0.51)0.14 (0.14, 0.39)-3.80.0001Thyroidectomy Total-1.53 (0.36)0.22 (0.22, 0.44)-4.2<.0001Ulcer0.72 (0.12)2.06 (2.06, 2.63)5.8<.0001Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.40 (0.05)1.49 (1.49, 1.64)7.9<.0001Comorbidities????Congestive Heart Failure0.33 (0.05)1.39 (1.39, 1.54)6.5<.0001Past Myocardial Infarction0.00 (0.07)1.00 (1.00, 1.14)0.00.9724Past Arrhythmia0.03 (0.05)1.03 (1.03, 1.13)0.60.5689Angina-0.11 (0.10)0.89 (0.89, 1.08)-1.20.2448Valvular Disease0.07 (0.05)1.08 (1.08, 1.18)1.60.1203Unstable Angina0.07 (0.12)1.07 (1.07, 1.35)0.60.5360Hypertension-0.35 (0.06)0.71 (0.71, 0.80)-5.6<.0001Diabetes-0.12 (0.05)0.89 (0.89, 0.97)-2.50.0111Renal Dysfunction1.37 (0.05)3.95 (3.95, 4.33)29.4<.0001Renal Failure0.25 (0.07)1.28 (1.28, 1.46)3.80.0001Liver Disease0.42 (0.05)1.53 (1.53, 1.69)7.9<.0001Cancer-0.09 (0.05)0.91 (0.91, 1.00)-1.90.0534Specific Abdominal Cancer0.41 (0.09)1.51 (1.51, 1.82)4.3<.0001Dementia0.41 (0.06)1.51 (1.51, 1.69)7.5<.0001Stroke0.07 (0.07)1.07 (1.07, 1.22)1.10.2838Seizure0.12 (0.14)1.13 (1.13, 1.48)0.90.3921Paraplegia0.17 (0.12)1.18 (1.18, 1.50)1.40.1716COPD0.38 (0.05)1.46 (1.46, 1.59)8.3<.0001Asthma-0.09 (0.07)0.92 (0.92, 1.06)-1.20.2363Post-inflammatory Pulmonary Fibrosis0.49 (0.09)1.63 (1.63, 1.94)5.6<.0001Hypothyroidism-0.05 (0.05)0.95 (0.95, 1.05)-1.00.3394Thrombocytopenia0.14 (0.10)1.15 (1.15, 1.39)1.40.1613Collagen Vascular Disease0.12 (0.08)1.13 (1.13, 1.32)1.40.1560Chronic Peptic Ulcer0.67 (0.25)1.94 (1.94, 3.15)2.70.0069Coagulopathy-0.16 (0.28)0.85 (0.85, 1.48)-0.60.5682Other Coagulopathy0.49 (0.07)1.63 (1.63, 1.87)7.1<.0001Cushing’s Disease-0.17 (0.65)0.85 (0.85, 3.00)-0.30.7953Graves’ Disease-0.24 (0.42)0.79 (0.79, 1.78)-0.60.5712Summary StatisticsNumber of Observations53,021Number of Deaths2,838C-statistic0.859 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic f. General Surgery Modern Era (2009-9/29/2010) Risk Model (Comorbidities Only).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-3.81 (0.06)Congestive Heart Failure0.43 (0.05)1.53 (1.53, 1.68)8.8<.0001Past Myocardial Infarction-0.05 (0.06)0.95 (0.95, 1.08)-0.70.4645Past Arrhythmia0.08 (0.05)1.08 (1.08, 1.18)1.70.0815Angina-0.16 (0.09)0.85 (0.85, 1.02)-1.70.0811Valvular Disease0.18 (0.05)1.20 (1.20, 1.31)4.00.0001Unstable Angina0.02 (0.11)1.02 (1.02, 1.28)0.20.8298Hypertension-0.34 (0.06)0.71 (0.71, 0.80)-5.7<.0001Diabetes-0.25 (0.04)0.78 (0.78, 0.84)-5.8<.0001Renal Dysfunction1.73 (0.05)5.66 (5.66, 6.18)38.4<.0001Renal Failure0.08 (0.06)1.09 (1.09, 1.22)1.40.1685Liver Disease0.30 (0.05)1.35 (1.35, 1.49)5.9<.0001Cancer0.05 (0.04)1.05 (1.05, 1.14)1.10.2593Specific Abdominal Cancer0.36 (0.08)1.44 (1.44, 1.67)4.7<.0001Dementia0.70 (0.05)2.01 (2.01, 2.23)13.4<.0001Stroke0.07 (0.06)1.07 (1.07, 1.22)1.10.2629Seizure0.12 (0.13)1.12 (1.12, 1.46)0.90.3846Paraplegia0.19 (0.12)1.21 (1.21, 1.53)1.70.0937COPD0.46 (0.04)1.58 (1.58, 1.72)10.6<.0001Asthma-0.17 (0.07)0.84 (0.84, 0.96)-2.50.0136Post-inflammatory Pulmonary Fibrosis0.49 (0.08)1.63 (1.63, 1.92)5.9<.0001Hypothyroidism-0.04 (0.05)0.96 (0.96, 1.05)-0.90.3797Thrombocytopenia0.20 (0.09)1.22 (1.22, 1.46)2.20.0287Collagen Vascular Disease0.13 (0.08)1.14 (1.14, 1.33)1.70.0982Chronic Peptic Ulcer1.02 (0.23)2.77 (2.77, 4.35)4.4<.0001Coagulopathy-0.01 (0.27)0.99 (0.99, 1.67)0.00.9631Other Coagulopathy0.59 (0.07)1.80 (1.80, 2.05)9.0<.0001Cushing’s Disease-0.11 (0.62)0.90 (0.90, 3.02)-0.20.8585Graves’ Disease-0.70 (0.39)0.50 (0.50, 1.07)-1.80.0757Hemoglobin Disorder0.38 (1.08)1.46 (1.46, 12.13)0.30.7288Summary StatisticsNumber of Observations53,021Number of Deaths2,838C-statistic0.792 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic g. Orthopedics Modern Era (2009-9/29/2010) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-5.93 (0.25)Age 65-69 (Reference)--?--?--?--?Age 70-740.13 (0.15)1.14 (1.14, 1.54)0.90.3754Age 75-790.64 (0.14)1.89 (1.89, 2.48)4.7<.0001Age 80-841.03 (0.13)2.81 (2.81, 3.63)7.8<.0001Age 85+1.60 (0.13)4.93 (4.93, 6.34)12.4<.0001Sex (Female)-0.44 (0.05)0.64 (0.64, 0.71)-8.4<.0001Emergent Admission0.54 (0.06)1.71 (1.71, 1.93)8.9<.0001Transfer-in0.30 (0.17)1.35 (1.35, 1.90)1.80.0773Past Admission in Last 6 Months-0.06 (0.06)0.94 (0.94, 1.06)-0.90.3449Principal Procedure Categories????Hip Repair1.20 (0.23)3.32 (3.32, 5.20)5.3<.0001Hip Replacement0.96 (0.22)2.60 (2.60, 4.04)4.3<.0001Hip Replacement Revision0.23 (0.27)1.26 (1.26, 2.15)0.80.4068Knee Replacement-0.25 (0.23)0.78 (0.78, 1.23)-1.10.2822Knee Replacement Revision (Reference)--?--?--?--?Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.35 (0.10)1.42 (1.42, 1.71)3.70.0003Comorbidities????Congestive Heart Failure0.55 (0.06)1.74 (1.74, 1.94)9.6<.0001Past Myocardial Infarction0.21 (0.08)1.24 (1.24, 1.44)2.70.0080Past Arrhythmia0.00 (0.06)1.00 (1.00, 1.11)0.00.9804Angina-0.37 (0.14)0.69 (0.69, 0.91)-2.60.0091Valvular Disease0.20 (0.05)1.22 (1.22, 1.36)3.70.0002Unstable Angina0.06 (0.18)1.06 (1.06, 1.50)0.40.7198Hypertension-0.40 (0.07)0.67 (0.67, 0.76)-5.8<.0001Diabetes-0.13 (0.06)0.88 (0.88, 0.98)-2.20.0253Renal Dysfunction0.84 (0.06)2.31 (2.31, 2.59)14.8<.0001Renal Failure0.17 (0.09)1.19 (1.19, 1.42)1.80.0648Liver Disease0.59 (0.11)1.80 (1.80, 2.21)5.5<.0001Cancer0.05 (0.06)1.05 (1.05, 1.18)0.90.3582Specific Abdominal Cancer0.77 (0.28)2.16 (2.16, 3.75)2.80.0058Dementia0.86 (0.05)2.37 (2.37, 2.64)16.0<.0001Stroke0.11 (0.07)1.11 (1.11, 1.27)1.60.1124Seizure0.23 (0.13)1.25 (1.25, 1.63)1.70.0928Paraplegia0.07 (0.14)1.07 (1.07, 1.41)0.50.6076COPD0.40 (0.05)1.49 (1.49, 1.66)7.4<.0001Asthma-0.29 (0.10)0.75 (0.75, 0.92)-2.80.0046Post-inflammatory Pulmonary Fibrosis0.36 (0.11)1.43 (1.43, 1.76)3.30.0009Hypothyroidism-0.11 (0.06)0.89 (0.89, 1.00)-2.00.0440Thrombocytopenia0.21 (0.13)1.23 (1.23, 1.60)1.50.1245Collagen Vascular Disease-0.35 (0.11)0.70 (0.70, 0.88)-3.10.0021Coagulopathy0.02 (0.33)1.02 (1.02, 1.95)0.10.9444Other Coagulopathy0.17 (0.10)1.18 (1.18, 1.44)1.70.0944Cushing’s Disease1.09 (0.87)2.97 (2.97, 16.21)1.30.2077Graves’ Disease0.02 (0.52)1.02 (1.02, 2.83)0.00.9711Summary StatisticsNumber of Observations110,509Number of Deaths1,919C-statistic0.887 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic h. Orthopedics Modern Era (2009-9/29/2010) Risk Model (Comorbidities Only).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.72 (0.07)0.01 (0.01, 0.01)-69.4<.0001Congestive Heart Failure0.87 (0.06)2.38 (2.38, 2.66)15.1<.0001Past Myocardial Infarction0.20 (0.08)1.22 (1.22, 1.42)2.50.0118Past Arrhythmia0.02 (0.05)1.03 (1.03, 1.14)0.50.6458Angina-0.41 (0.14)0.66 (0.66, 0.88)-2.90.0039Valvular Disease0.35 (0.05)1.41 (1.41, 1.57)6.4<.0001Unstable Angina0.07 (0.17)1.07 (1.07, 1.51)0.40.6912Hypertension-0.46 (0.07)0.63 (0.63, 0.72)-6.7<.0001Diabetes-0.29 (0.06)0.75 (0.75, 0.84)-5.2<.0001Renal Dysfunction1.08 (0.06)2.95 (2.95, 3.29)19.3<.0001Renal Failure0.17 (0.09)1.19 (1.19, 1.42)1.90.0596Liver Disease0.46 (0.10)1.59 (1.59, 1.95)4.5<.0001Cancer0.15 (0.05)1.16 (1.16, 1.29)2.70.0065Specific Abdominal Cancer0.97 (0.28)2.65 (2.65, 4.57)3.50.0005Dementia1.73 (0.05)5.64 (5.64, 6.22)34.4<.0001Stroke0.15 (0.07)1.16 (1.16, 1.33)2.20.0261Seizure0.23 (0.13)1.26 (1.26, 1.64)1.70.0834Paraplegia0.12 (0.14)1.13 (1.13, 1.48)0.90.3855COPD0.51 (0.05)1.66 (1.66, 1.84)9.5<.0001Asthma-0.55 (0.10)0.57 (0.57, 0.70)-5.6<.0001Post-inflammatory Pulmonary Fibrosis0.49 (0.11)1.62 (1.62, 2.00)4.5<.0001Hypothyroidism-0.11 (0.06)0.89 (0.89, 1.00)-2.00.0406Thrombocytopenia0.21 (0.13)1.23 (1.23, 1.60)1.50.1224Collagen Vascular Disease-0.58 (0.11)0.56 (0.56, 0.70)-5.2<.0001Chronic Peptic Ulcer-0.33 (1.02)0.72 (0.72, 5.34)-0.30.7445Coagulopathy0.04 (0.33)1.04 (1.04, 1.97)0.10.8957Other Coagulopathy0.11 (0.10)1.11 (1.11, 1.35)1.10.2828Cushing’s Disease0.94 (0.84)2.56 (2.56, 13.37)1.10.2645Graves’ Disease-0.33 (0.52)0.72 (0.72, 1.98)-0.60.5206Summary StatisticsNumber of Observations110,509Number of Deaths1,919C-statistic0.836 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic i. General Surgery Modern Era (10/1/2010-2013) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.20 (0.08)Age 65-69 (Reference)--?--?--?--?Age 70-740.17 (0.05)1.18 (1.18, 1.32)3.10.0021Age 75-790.43 (0.05)1.54 (1.54, 1.71)8.2<.0001Age 80-840.71 (0.05)2.04 (2.04, 2.26)13.4<.0001Age 85+1.09 (0.05)2.98 (2.98, 3.30)20.8<.0001Sex (female)-0.05 (0.03)0.95 (0.95, 1.01)-1.60.1145Emergent Admission0.60 (0.03)1.82 (1.82, 1.94)18.1<.0001Transfer-in0.62 (0.06)1.86 (1.86, 2.10)10.0<.0001Past Admission in Last 6 Months0.05 (0.03)1.05 (1.05, 1.12)1.40.1625Principal Procedure Categories????Adrenalectomy-1.74 (0.59)0.18 (0.18, 0.56)-2.90.0034Appendectomy-1.49 (0.13)0.23 (0.23, 0.29)-11.1<.0001Bariatric-1.83 (0.38)0.16 (0.16, 0.34)-4.8<.0001Biliary common duct-0.57 (0.50)0.57 (0.57, 1.50)-1.10.2516Biliary other-0.52 (0.21)0.60 (0.60, 0.90)-2.50.0134Cholecystectomy-1.31 (0.05)0.27 (0.27, 0.30)-24.7<.0001Colectomy Partial - Lap-1.13 (0.08)0.32 (0.32, 0.38)-14.0<.0001Colectomy Partial – Open (Reference)--?--?--?--?Colectomy Total - Lap-0.43 (0.44)0.65 (0.65, 1.52)-1.00.3196Colectomy Total - Open0.71 (0.08)2.04 (2.04, 2.40)8.6<.0001Esophagectomy or Esophagomyotomy-0.44 (0.21)0.64 (0.64, 0.97)-2.10.0346Hernia Abdominal – Lap-1.24 (0.26)0.29 (0.29, 0.48)-4.8<.0001Hernia Abdominal – Open -0.90 (0.10)0.41 (0.41, 0.49)-9.4<.0001Hernia Groin – Lap -1.71 (0.46)0.18 (0.18, 0.44)-3.70.0002Hernia Groin – Open-1.24 (0.11)0.29 (0.29, 0.35)-11.8<.0001Large Bowel Other-0.01 (0.14)0.99 (0.99, 1.31)-0.10.9564Liver Procedures-0.81 (0.52)0.44 (0.44, 1.24)-1.60.1210Liver Partial Hepatectomy-0.87 (0.16)0.42 (0.42, 0.58)-5.4<.0001Lysis of Adhesions-0.49 (0.07)0.61 (0.61, 0.70)-7.3<.0001Mastectomy-1.71 (0.19)0.18 (0.18, 0.27)-8.8<.0001Pancreatectomy-0.75 (0.11)0.47 (0.47, 0.59)-6.6<.0001Parathyroidectomy-2.15 (0.34)0.12 (0.12, 0.23)-6.3<.0001PD Access Procedure-0.78 (0.18)0.46 (0.46, 0.66)-4.3<.0001Proctectomy-0.75 (0.11)0.47 (0.47, 0.58)-7.1<.0001Proctopexy-2.32 (1.01)0.10 (0.10, 0.71)-2.30.0213Pyloroplasty0.05 (0.33)1.05 (1.05, 1.99)0.10.8861Small Bowel Other-0.34 (0.14)0.71 (0.71, 0.94)-2.40.0165Small Bowel Resection0.12 (0.05)1.13 (1.13, 1.23)2.60.0106Splenectomy0.13 (0.13)1.14 (1.14, 1.48)1.00.3320Stomach Anti-Reflux-1.24 (0.36)0.29 (0.29, 0.59)-3.40.0006Stomach Gastric Bypass (non-bariatric)0.49 (0.14)1.63 (1.63, 2.14)3.50.0004Stomach Other0.31 (0.19)1.36 (1.36, 1.96)1.70.0971Stomach Partial Gastrectomy0.00 (0.10)1.00 (1.00, 1.22)0.00.9677Stomach Total Gastrectomy0.04 (0.20)1.04 (1.04, 1.55)0.20.8595Thyroidectomy Partial-2.36 (0.50)0.09 (0.09, 0.25)-4.7<.0001Thyroidectomy Substernal-1.55 (0.72)0.21 (0.21, 0.86)-2.20.0298Thyroidectomy Total-2.25 (0.38)0.11 (0.11, 0.22)-5.9<.0001Ulcer0.46 (0.09)1.59 (1.59, 1.89)5.3<.0001Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.31 (0.03)1.37 (1.37, 1.47)9.0<.0001Comorbidities????Congestive Heart Failure0.36 (0.03)1.43 (1.43, 1.53)10.3<.0001Past Myocardial Infarction0.05 (0.04)1.05 (1.05, 1.14)1.20.2285Past Arrhythmia0.04 (0.03)1.04 (1.04, 1.11)1.20.2275Angina-0.29 (0.07)0.75 (0.75, 0.86)-4.00.0001Valvular Disease0.15 (0.03)1.16 (1.16, 1.24)4.6<.0001Unstable Angina0.18 (0.08)1.20 (1.20, 1.40)2.20.0266Hypertension-0.22 (0.05)0.80 (0.80, 0.88)-4.5<.0001Diabetes-0.08 (0.03)0.92 (0.92, 0.98)-2.70.0072Renal Dysfunction1.18 (0.03)3.25 (3.25, 3.46)36.1<.0001Renal Failure0.29 (0.04)1.34 (1.34, 1.46)6.5<.0001Liver Disease0.34 (0.04)1.40 (1.40, 1.51)9.2<.0001Cancer-0.02 (0.03)0.98 (0.98, 1.05)-0.60.5816Specific Abdominal Cancer0.54 (0.07)1.71 (1.71, 1.95)8.0<.0001Dementia0.38 (0.04)1.46 (1.46, 1.57)10.1<.0001Stroke-0.02 (0.04)0.98 (0.98, 1.07)-0.40.6788Seizure0.37 (0.08)1.44 (1.44, 1.70)4.4<.0001Paraplegia0.33 (0.08)1.40 (1.40, 1.63)4.3<.0001COPD0.42 (0.03)1.51 (1.51, 1.61)13.2<.0001Asthma-0.10 (0.05)0.91 (0.91, 1.00)-2.00.0458Post-inflammatory Pulmonary Fibrosis0.32 (0.06)1.37 (1.37, 1.55)5.2<.0001Hypothyroidism-0.05 (0.03)0.95 (0.95, 1.02)-1.40.1724Thrombocytopenia0.18 (0.06)1.20 (1.20, 1.35)3.00.0026Collagen Vascular Disease0.05 (0.06)1.05 (1.05, 1.17)0.90.3538Chronic Peptic Ulcer0.24 (0.20)1.27 (1.27, 1.89)1.20.2286Coagulopathy-0.06 (0.18)0.94 (0.94, 1.34)-0.30.7439Other Coagulopathy0.67 (0.05)1.95 (1.95, 2.14)14.4<.0001Cushing’s Disease0.46 (0.36)1.59 (1.59, 3.22)1.30.1979Graves’ Disease-0.40 (0.28)0.67 (0.67, 1.16)-1.40.1549Hemoglobin Disorder-0.39 (0.75)0.67 (0.67, 2.95)-0.50.6015Summary StatisticsNumber of Observations113,644Number of Deaths5,779C-statistic0.851 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic j. General Surgery Modern Era (10/1/2010-2013) Risk Model (Comorbidities Only Model).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-4.04 (0.05)Congestive Heart Failure0.45 (0.03)1.58 (1.58, 1.68)13.5<.0001Past Myocardial Infarction-0.02 (0.04)0.98 (0.98, 1.06)-0.40.6672Past Arrhythmia0.11 (0.03)1.12 (1.12, 1.19)3.60.0003Angina-0.34 (0.07)0.71 (0.71, 0.81)-4.9<.0001Valvular Disease0.25 (0.03)1.28 (1.28, 1.36)7.9<.0001Unstable Angina0.16 (0.08)1.17 (1.17, 1.36)2.10.0396Hypertension-0.15 (0.05)0.86 (0.86, 0.95)-3.20.0016Diabetes-0.26 (0.03)0.77 (0.77, 0.82)-8.5<.0001Renal Dysfunction1.48 (0.03)4.41 (4.41, 4.70)46.8<.0001Renal Failure0.18 (0.04)1.20 (1.20, 1.30)4.4<.0001Liver Disease0.21 (0.03)1.24 (1.24, 1.32)6.1<.0001Cancer0.08 (0.03)1.09 (1.09, 1.15)2.90.0041Specific Abdominal Cancer0.38 (0.05)1.47 (1.47, 1.63)7.1<.0001Dementia0.69 (0.04)1.99 (1.99, 2.14)19.5<.0001Stroke0.00 (0.04)1.00 (1.00, 1.08)0.00.9922Seizure0.30 (0.08)1.35 (1.35, 1.59)3.80.0002Paraplegia0.31 (0.08)1.36 (1.36, 1.58)4.1<.0001COPD0.48 (0.03)1.61 (1.61, 1.71)15.8<.0001Asthma-0.15 (0.05)0.86 (0.86, 0.94)-3.20.0012Post-inflammatory Pulmonary Fibrosis0.39 (0.06)1.48 (1.48, 1.66)6.6<.0001Hypothyroidism-0.03 (0.03)0.97 (0.97, 1.03)-1.00.3076Thrombocytopenia0.17 (0.06)1.19 (1.19, 1.33)3.00.0027Collagen Vascular Disease0.07 (0.05)1.07 (1.07, 1.19)1.30.2012Chronic Peptic Ulcer0.57 (0.19)1.76 (1.76, 2.57)2.90.0034Coagulopathy-0.04 (0.18)0.96 (0.96, 1.35)-0.20.8170Other Coagulopathy0.77 (0.04)2.17 (2.17, 2.36)17.6<.0001Cushing’s Disease0.24 (0.33)1.27 (1.27, 2.40)0.70.4657Graves’ Disease-0.68 (0.27)0.51 (0.51, 0.86)-2.50.0119Hemoglobin Disorder-0.59 (0.75)0.56 (0.56, 2.40)-0.80.4323Summary StatisticsNumber of Observations113,644Number of Deaths5,779C-statistic0.791 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic k. Orthopedics Modern Era (10/1/2010-2013) Risk Model.CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-6.36 (0.17)0.00 (0.00, 0.00)-38.20.0000Age 65-69 (Reference)--?------Age 70-740.35 (0.10)1.41 (1.41, 1.72)3.50.0005Age 75-790.74 (0.09)2.10 (2.10, 2.52)8.00.0000Age 80-841.04 (0.09)2.83 (2.83, 3.37)11.60.0000Age 85+1.68 (0.09)5.38 (5.38, 6.38)19.30.0000Sex (Female)-0.44 (0.03)0.64 (0.64, 0.69)-13.00.0000Emergent Admission0.66 (0.04)1.94 (1.94, 2.10)16.90.0000Transfer-in0.72 (0.10)2.06 (2.06, 2.48)7.60.0000Past Admission in Last 6 Months-0.06 (0.04)0.94 (0.94, 1.01)-1.60.1108Principal Procedure Categories????Hip Repair1.13 (0.15)3.09 (3.09, 4.11)7.70.0000Hip Replacement0.96 (0.14)2.60 (2.60, 3.45)6.60.0000Hip Replacement Revision0.40 (0.17)1.49 (1.49, 2.08)2.40.0180Knee Replacement-0.31 (0.15)0.73 (0.73, 0.98)-2.10.0390Knee Replacement Revision (Reference)--?------Same-Day Secondary Procedures????Major Operative Therapeutic Procedure0.42 (0.06)1.53 (1.53, 1.72)7.10.0000Comorbidities????Congestive Heart Failure0.55 (0.04)1.73 (1.73, 1.86)14.80.0000Past Myocardial Infarction0.08 (0.05)1.08 (1.08, 1.19)1.70.0903Past Arrhythmia0.06 (0.04)1.06 (1.06, 1.14)1.70.0967Angina-0.14 (0.09)0.87 (0.87, 1.03)-1.60.1106Valvular Disease0.19 (0.04)1.21 (1.21, 1.29)5.30.0000Unstable Angina-0.03 (0.12)0.97 (0.97, 1.23)-0.30.7876Hypertension-0.23 (0.05)0.80 (0.80, 0.88)-4.60.0000Diabetes-0.06 (0.04)0.94 (0.94, 1.01)-1.80.0756Renal Dysfunction0.71 (0.04)2.04 (2.04, 2.19)19.90.0000Renal Failure0.27 (0.06)1.31 (1.31, 1.47)4.50.0000Liver Disease0.65 (0.07)1.92 (1.92, 2.19)9.80.0000Cancer0.07 (0.03)1.08 (1.08, 1.15)2.10.0331Specific Abdominal Cancer0.60 (0.20)1.81 (1.81, 2.68)3.00.0026Dementia0.94 (0.03)2.57 (2.57, 2.75)27.10.0000Stroke0.12 (0.04)1.12 (1.12, 1.21)2.90.0041Seizure0.16 (0.09)1.18 (1.18, 1.40)1.80.0670Paraplegia0.18 (0.09)1.19 (1.19, 1.42)2.00.0406COPD0.47 (0.03)1.60 (1.60, 1.72)13.60.0000Asthma-0.11 (0.06)0.90 (0.90, 1.01)-1.90.0641Post-inflammatory Pulmonary Fibrosis0.26 (0.07)1.30 (1.30, 1.48)3.80.0001Hypothyroidism-0.09 (0.04)0.91 (0.91, 0.98)-2.50.0115Thrombocytopenia-0.03 (0.09)0.97 (0.97, 1.14)-0.40.7058Collagen Vascular Disease-0.18 (0.07)0.83 (0.83, 0.95)-2.80.0056Coagulopathy0.11 (0.20)1.12 (1.12, 1.67)0.50.5919Other Coagulopathy0.27 (0.07)1.31 (1.31, 1.49)4.00.0001Cushing’s Disease0.45 (0.73)1.57 (1.57, 6.60)0.60.5398Graves’ Disease-0.49 (0.43)0.62 (0.62, 1.42)-1.10.2533Summary StatisticsNumber of Observations263,714Number of Deaths4,571C-statistic0.898 REF TableS4 \h \* MERGEFORMAT eTable4 seq Serial \* alphabetic l. Orthopedics Modern Era (10/1/2010-2013) Risk Model (Comorbidities Only).CovariateEstimate (SE)Odds Ratio (95% CI)Chi-SquareP-valueIntercept-5.10 (0.05)0.01 (0.01, 0.01)-103.30.0000Congestive Heart Failure0.82 (0.04)2.27 (2.27, 2.44)22.00.0000Past Myocardial Infarction0.11 (0.05)1.12 (1.12, 1.23)2.40.0166Past Arrhythmia0.11 (0.03)1.12 (1.12, 1.20)3.20.0012Angina-0.22 (0.09)0.80 (0.80, 0.95)-2.50.0113Valvular Disease0.34 (0.03)1.40 (1.40, 1.50)9.60.0000Unstable Angina-0.06 (0.12)0.95 (0.95, 1.20)-0.50.6439Hypertension-0.22 (0.05)0.81 (0.81, 0.89)-4.40.0000Diabetes-0.23 (0.04)0.79 (0.79, 0.85)-6.60.0000Renal Dysfunction0.97 (0.04)2.64 (2.64, 2.83)27.20.0000Renal Failure0.25 (0.06)1.28 (1.28, 1.44)4.20.0000Liver Disease0.51 (0.07)1.67 (1.67, 1.90)7.90.0000Cancer0.18 (0.03)1.20 (1.20, 1.28)5.50.0000Specific Abdominal Cancer0.75 (0.20)2.11 (2.11, 3.12)3.80.0002Dementia1.84 (0.03)6.30 (6.30, 6.72)56.20.0000Stroke0.19 (0.04)1.21 (1.21, 1.31)4.80.0000Seizure0.06 (0.09)1.06 (1.06, 1.27)0.70.4844Paraplegia0.18 (0.09)1.20 (1.20, 1.42)2.10.0377COPD0.56 (0.03)1.76 (1.76, 1.88)16.40.0000Asthma-0.36 (0.06)0.70 (0.70, 0.78)-6.30.0000Post-inflammatory Pulmonary Fibrosis0.38 (0.07)1.46 (1.46, 1.66)5.60.0000Hypothyroidism-0.09 (0.03)0.91 (0.91, 0.98)-2.60.0107Thrombocytopenia-0.03 (0.08)0.97 (0.97, 1.15)-0.30.7543Collagen Vascular Disease-0.42 (0.07)0.66 (0.66, 0.75)-6.30.0000Coagulopathy0.08 (0.20)1.08 (1.08, 1.62)0.40.6887Other Coagulopathy0.24 (0.07)1.27 (1.27, 1.45)3.70.0002Cushing’s Disease0.11 (0.73)1.12 (1.12, 4.66)0.20.8754Graves’ Disease-0.68 (0.42)0.51 (0.51, 1.15)-1.60.1053Summary StatisticsNumber of Observations263,714Number of Deaths4,571C-statistic0.856eTable seq NumList 5. Prolonged Length of Stay. A prolonged stay is defined as exceeding the length of stay at which the rate of discharge begins to decline (the Hollander-Proschan point)PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TaWxiZXI8L0F1dGhvcj48WWVhcj4xOTk5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 6-9 or in-hospital death. In-hospital deaths are included to avoid giving inappropriate credit for the early death of a patient. The cutpoints for defining a prolonged stay were estimated separately for each procedure category and era using a dataset of 1,785,808 patients not used for matching. Procedure CategoryHP Cutpoint (Days)TraditionalModernAdrenalectomy43Appendectomy43Bariatric53Biliary Common Duct98Biliary Other77Cholecystectomy34Colectomy Partial - LapN/A5Colectomy Partial - Open76Colectomy Total - LapN/A4Colectomy Total - Open914Esophagectomy99Esophagomyotomy32Hernia Abdominal – LapN/A3Hernia Abdominal – Open34Hernia Groin – LapN/A3Hernia Groin – Open33Hip Repair66Hip Replacement55Hip Replacement Revision55Knee Replacement55Knee Replacement Revision55Large Bowel Other76Liver Other67Liver Partial Hepatectomy76Lysis Of Adhesions98Mastectomy33Pancreatectomy97Parathyroidectomy33Pd Access Procedure38Proctectomy86Proctopexy95Pyloroplasty1111Small Bowel Other98Small Bowel Resection87Splenectomy54Stomach Anti-Reflux33Stomach Gastric Bypass1513Stomach Other76Stomach Partial Gastrectomy87Stomach Total Gastrectomy109Thyroidectomy Partial34Thyroidectomy Substernal23Thyroidectomy Total33Ulcer88eTable seq NumList 6. Pooled Cohort Patient Characteristics. Describes the group of new surgeon patients after randomly sampling 10 patients per new surgeon, but before matching to experienced surgeons.Covariate (percent unless noted)All New Surgeon Patients before MatchAll Experienced Surgeon Patients before MatchNumber of Surgeons4,88115,041Number of Patients48,8101,434,264Number of Hospitals1,9021,902Patient DemographicsAge at Admission (years, mean)79.277.1Age 65-6915.319.8Age 70-7419.123.9Age 75-7920.322.8Age 80-8419.817.6Age 85+25.615.9Sex (% female)65.964.4Year of admission (mean)2005.82005.9Admission after 9/30/201037.733.1Admission in 2012 or 201323.518.0Emergent Admission50.125.0Transfer-in2.61.4Past Admission in Last 6 Months26.019.7Traditional Probability of 30-day Death (Using all risk factors)6.14.0Modern Probability of 30-day Death (Using all risk factors)5.42.7Propensity Score for Treatment by a New Surgeon (Traditional)11.78.7Propensity Score for Treatment by a New Surgeon (Modern)13.77.1Comorbidity Count (mean) 3.73.3Principal Procedure CategoriesGeneral SurgeryAdrenalectomy0.20.2Appendectomy4.63.0Bariatric0.30.6Biliary common duct0.10.1Biliary other0.30.6Cholecystectomy29.924.4Colectomy Partial - Lap3.83.7Colectomy Partial – Open 22.422.5Colectomy Total - Lap0.10.1Colectomy Total - Open1.10.9Esophagectomy0.10.4Esophagomyotomy0.10.1Hernia Abdominal – Lap0.60.5Hernia Abdominal – Open 3.85.4Hernia Groin – Lap 0.20.1Hernia Groin – Open4.13.8Large Bowel Other0.90.8Liver Other0.10.2Liver Partial Hepatectomy0.30.8Lysis of Adhesions4.84.0Mastectomy3.86.5Pancreatectomy0.61.7Parathyroidectomy0.61.5PD Access Procedure0.30.4Proctectomy3.33.7Proctopexy0.10.1Pyloroplasty0.20.1Small Bowel Other0.70.6Small Bowel Resection6.85.0Splenectomy0.80.9Stomach Anti-Reflux0.71.1Stomach Gastric Bypass (non-bariatric)0.40.5Stomach Other0.30.3Stomach Partial Gastrectomy1.11.5Stomach Total Gastrectomy0.20.5Thyroidectomy Partial0.51.2Thyroidectomy Substernal0.10.1Thyroidectomy Total0.41.1Ulcer1.61.0Orthopedic SurgeryHip Repair34.413.0Hip Replacement45.334.4Hip Replacement Revision2.43.5Knee Replacement16.245.8Knee Replacement Revision1.73.3Same-Day Secondary ProceduresMajor Operative Therapeutic Procedure23.919.6ComorbiditiesCongestive Heart Failure22.415.5Past Myocardial Infarction9.68.1Past Arrhythmia26.424.2Angina5.85.2Valvular Disease21.418.0Unstable Angina2.72.2Hypertension78.578.0Diabetes27.725.8Renal Dysfunction15.310.4Renal Failure5.13.5Liver Disease7.86.3Cancer33.634.1Specific Abdominal Cancer1.92.2Dementia20.511.0Stroke13.89.7Seizure1.71.2Paraplegia2.81.7COPD26.721.2Asthma7.78.4Post-inflammatory Pulmonary Fibrosis3.72.8Hypothyroidism21.421.6Thrombocytopenia2.11.7Collagen Vascular Disease6.37.1AIDS0.10.0Chronic Peptic Ulcer0.20.2Coagulopathy0.40.4Other Coagulopathy4.34.0Cushing’s Disease0.10.1Graves’ Disease0.30.4Hemoglobin Disorder0.00.0References ADDIN EN.REFLIST 1.Fingar KR, Stocks C, Weiss AJ, et al. Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012. Rockville, MD: Agency for Healthcare Research and Quality, December 2014. (HCUP Statistical Brief #186) ().2.Pimentel SD, Kelz RR, Silber JH, et al. Large, sparse optimal matching with refined covariate balance in an observational study of the health outcomes produced by new surgeons. J Am Stat Assoc 2015;110:515-27.3.Mahalanobis PC. On the generalized distance in statistics. Proceedings of the National Institute of Sciences of India 1936;2:49-55.4.Rubin DB. Bias reduction using Mahalanobis metric matching. Biometrics 1980;36:293-98.5.Rosenbaum PR. Chapter 9: Various Practical Issues in Matching. In: Design of Observational Studies. New York: Springer, 2010:187-96.6.Silber JH, Rosenbaum PR, Koziol LF, et al. Conditional length of stay. Health Serv Res 1999;34:349-63.7.Silber JH, Rosenbaum PR, Even-Shoshan O, et al. Length of stay, conditional length of stay, and prolonged stay in pediatric asthma. Health Serv Res 2003;38:867-86.8.Silber JH, Rosenbaum PR, Rosen AK, et al. Prolonged hospital stay and the resident duty hour rules of 2003. Med Care 2009;47:1191-200.9.Silber JH, Rosenbaum PR, Kelz RR, et al. Medical and financial risks associated with surgery in the elderly obese. Ann Surg 2012;256:79-86. ................
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