RT Journal
A1 Ingraham AM, Haas B, Cohen ME, Ko CY, Nathens AB
T1 Comparison of hospital performance in trauma vs emergency and elective general surgery: Implications for acute care surgery quality improvement
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD July 1
VO 147
IS 7
SP 591
OP 598
DO 10.1001/archsurg.2012.71
UL http://dx.doi.org/10.1001/archsurg.2012.71
AB Hypotheses 
                  As emergency general surgery (EMGS) and trauma care are increasingly being provided by the same personnel with overlapping resources, we postulated that the quality of care provided to EMGS and trauma patients would be similar. We also evaluated the relationship between trauma and elective general surgery (ELGS) care, believing that performance would be similar across these services as it reflects institutional culture.Design 
                  Retrospective cohort study comparing hospital performance in trauma and EMGS care and in trauma and ELGS care. Regression models for mortality and serious morbidity were constructed for trauma, EMGS, and ELGS hospitals contributing to both the National Trauma Data Bank (2007) and American College of Surgeons National Surgical Quality Improvement Program (2005-2008).Setting 
                  Forty-six hospitals.Main Outcome Measures 
                  Correlations of observed to expected ratios were examined. Outlier status (hospitals with CIs of observed to expected ratios excluding 1.0) was compared using weighted κ.Results 
                  There was no significant relationship between trauma and EMGS mortality (r = −0.01, P = .94; κ = −0.10, P = .61) or between trauma and ELGS mortality (r = 0.23, P = .12; κ = 0.07, P = .62). There was no significant relationship between trauma and EMGS morbidity (r = 0.21, P = .17; κ = 0.04, P = .63) or between trauma and ELGS morbidity (r = 0.16, P = .30; κ = 0.11, P = .37). No hospitals were consistently low or high outliers across all 3 groups.Conclusions 
                  Trauma performance improvement programs are well established compared with those for EMGS. Although EMGS patients use similar structures and processes as trauma patients, there is a lack of correlation between the quality of care provided to trauma and EMGS patients; EMGS should be incorporated into trauma performance improvement programs.