Trauma Program Value Assessment at an Academic Health Network System Over 12 Years

• Published in: The American surgeon 2024-11, Vol.90 (11), p.2958-2968
• Main Authors: Abdelmasseh, Michael, Cuaranta, Araceli, Thompson, Errington, Finley, Robert K., Payne, Barbara, Tian, Jing, Gorka, Alexei, Willis, Jonathan, Kadiyala, Vineela, Sanabria, Juan R.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adult; Aged; Complications; Diagnosis related groups; DRGs; Expected values; Female; Health care facilities; Health care networks; Health care policy; Hospitals; Humans; Injuries; Injury Severity Score; Laparotomy; Length of stay; Length of Stay - statistics & numerical data; Male; Medicaid; Medicare; Middle Aged; Multivariate analysis; Ostomy; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Patient Satisfaction; Patients; Postoperative; Postoperative Complications - epidemiology; Program Evaluation; Prospective Studies; Reimbursement; Retrospective Studies; Trauma; Trauma Centers; Tuberculosis; Wounds and Injuries - surgery
• ISSN: 0003-1348; 1555-9823; 1555-9823
• DOI: 10.1177/00031348241259045

Background Trauma is a leading cause of global death, with 200 000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. Methods Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS 15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. Results 41,927 trauma evaluations were performed, leading to 16 044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7 Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. Conclusions The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.