More operations, more deaths? relationship between operative intervention rates and risk-adjusted mortality at trauma centers

Shahid Shafi, Jennifer Parks, Chul Ahn, Larry M. Gentilello, Avery B. Nathens

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: The Trauma Quality Improvement Project has demonstrated significant variations in risk-adjusted mortality rates across the designated trauma centers. It is not known whether the outcome differences are related to provider-level clinical decision making. We hypothesized that centers with good outcomes undertake critical operative interventions aggressively, thereby avoiding complications and deaths. Methods: The previously validated Trauma Quality Improvement Project risk-adjustment algorithm was used to measure observed-to-expected mortality rates (O/E with 90% confidence intervals [CI]) for 152 Level I and II trauma centers participating in the National Trauma Data Bank (version 7.0). Adult patients (≥16 years) with at least one severe injury (Abbreviated Injury Scale score ≥3) were included (N = 135,654). Operative intervention rates for solid organ injuries (spleen, liver, and kidney) were compared between the centers classified as high mortality (O/E with CI > 1, n = 35 centers) versus low mortality (O/E with CI < 1, n = 37 centers) using nonparametric tests. Results: Low- and high-mortality trauma centers were similar in designation level, hospital and intensive care unit beds, teaching status, and number of trauma, orthopedic, and neurosurgeons. Despite a similar incidence and severity of solid organ injuries, low-mortality centers were less likely to undertake operative interventions. Conclusion: Trauma centers with higher risk-adjusted mortality rates are more likely to undertake operative interventions for solid organ injuries. Hence, there is a need to focus quality improvement efforts on medical decision-making and perioperative processes of care.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number1
DOIs
StatePublished - Jul 2010

Fingerprint

Trauma Centers
Mortality
Wounds and Injuries
Quality Improvement
Confidence Intervals
Abbreviated Injury Scale
Perioperative Care
Risk Adjustment
Orthopedics
Intensive Care Units
Teaching
Spleen
Databases
Kidney
Liver
Incidence

Keywords

  • Operative interventions
  • Risk-adjusted mortality
  • Trauma Quality Improvement Project

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

More operations, more deaths? relationship between operative intervention rates and risk-adjusted mortality at trauma centers. / Shafi, Shahid; Parks, Jennifer; Ahn, Chul; Gentilello, Larry M.; Nathens, Avery B.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 69, No. 1, 07.2010, p. 70-77.

Research output: Contribution to journalArticle

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