Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery

Amulya Vadlakonda; Nam Yong Cho; Zachary Tran; Joanna Curry; Sara Sakowitz; Jeffrey Balian; Troy Coaston; Areti Tillou; Peyman Benharash

doi:10.1016/j.surg.2024.03.045

Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery

Surgery. 2024 May 17:S0039-6060(24)00210-1. doi: 10.1016/j.surg.2024.03.045. Online ahead of print.

Authors

Amulya Vadlakonda¹, Nam Yong Cho¹, Zachary Tran², Joanna Curry¹, Sara Sakowitz¹, Jeffrey Balian¹, Troy Coaston¹, Areti Tillou³, Peyman Benharash⁴

Affiliations

¹ Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA.
² Department of Surgery, Loma Linda University Health, Loma Linda, CA.
³ Division of Trauma and Acute Care Surgery, University of California, Los Angeles, CA.
⁴ Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address: PBenharash@mednet.ucla.edu.

PMID: 38760230
DOI: 10.1016/j.surg.2024.03.045

Abstract

Background: Recent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality.

Methods: Adults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume.

Results: Of an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12-1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume.

Conclusion: We note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model.