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

The Journal of Trauma
Shahid ShafiAvery B Nathens

Abstract

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. 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 (>or=16 years) with at least one severe injury (Abbreviated Injury Scale score >or=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. 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 ne...Continue Reading

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Dec 25, 2003·Surgery·Liane S FeldmanGerald M Fried
Jul 5, 2005·The Journal of Trauma·Lenworth M JacobsWilliam T Marshall
Jan 27, 2006·The New England Journal of Medicine·Ellen J MacKenzieDaniel O Scharfstein
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Citations

Jan 25, 2012·World Journal of Emergency Surgery : WJES·Salomone Di SaverioFausto Catena
Jul 21, 2014·Journal of the American College of Surgeons·Shahid ShafiJohn Holcomb
Nov 22, 2011·Radiologic Clinics of North America·Alexis Boscak, Kathirkamanthan Shanmuganathan
Aug 30, 2014·The Journal of Surgical Research·Matthew L DavisAvery B Nathens
Mar 28, 2012·The British Journal of Surgery·J SkattumC Gaarder
Oct 5, 2010·Current Opinion in Critical Care·Christine S Cocanour
Aug 3, 2011·The Journal of Trauma·Ben L ZarzaurTimothy C Fabian
Apr 12, 2012·The Journal of Trauma and Acute Care Surgery·Shahid ShafiDavid Ballard
Jul 3, 2013·Proceedings·Justin SobrinoShahid Shafi
Jan 21, 2014·Annals of Surgery·Alex M AlmoudarisOmar Faiz

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