TIME TO OR FOR PATIENTS WITH ABDOMINAL GUNSHOT WOUNDS: A POTENTIAL PROCESS MEASURE TO ASSESS THE QUALITY OF TRAUMA CARE?

J Trauma Acute Care Surg. 2022 Jan 6. doi: 10.1097/TA.0000000000003511. Online ahead of print.

Abstract

Background: Abdominal gunshot wounds (GSW) require rapid assessment and operative intervention to reduce the risk of death and complications. We sought to determine if time to the operating room (OR) might be a useful process measure for the assessment of trauma care quality. We evaluated the facility benchmark time to OR for patients with serious injury and whether this was associated with lower rates of complications and mortality.

Methods: We evaluated time to OR for adult patients with an abdominal GSW presenting in shock to ACS TQIP centers from 2015-20. We calculated the 75th percentile time to the OR for each center and characterized centers as average, slow, or fast. We compared patient and facility characteristics across outlier status as well as risk adjusted complications and mortality using hierarchical multivariable logistic regression models.

Results: 4,027 patients in 230 centers met inclusion criteria. Mortality was 28%. There were 61 (27%) fast and 52 (23%) slow centers. The median time for slow centers was 83 min (68-94) compared to fast centers, 35 min (32-38). ISS and ED vital signs were similar across centers. Fast hospitals had higher total case volumes, more cases per surgeon, and were more likely to be level 1 centers. Patients cared for in these centers had similar risk-adjusted rates of complications and mortality.

Conclusions: Time to OR for patients with abdominal GSWs and shock might be a useful process measure to evaluate rapid decision making and OR access. Surgeon and center experience as measured by annual case volumes, coupled with a rapid surgical response required through level 1 trauma center standards might be contributory. There was no association between outlier status and complications or mortality suggesting other factors apart from time to the operating room are of greater significance.

Level of evidence: Level IV Therapeutic / Care Management.