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Surgeon- and system-based influences on trauma mortality.
Elliott R Haut1, David C Chang, Awori J Hayanga
1Department of Surgery, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Osler Bldg, Room 625, Baltimore, MD 21287, USA. ehaut1@jhmi.edu
Archives of Surgery (Chicago, Ill. : 1960)
|August 19, 2009
Summary
In trauma care, a structured program and senior surgeon mentoring significantly improve patient outcomes, overriding individual surgeon experience. This demonstrates the system effect in reducing mortality.
Area of Science:
- Trauma Surgery
- Healthcare Systems Research
- Patient Outcomes
Background:
- Trauma systems aim to improve patient survival, but the specific mechanisms are not fully understood.
- Potential factors include surgeon experience (surgeon effect) versus the overall care system (system effect).
Purpose of the Study:
- To investigate whether mortality differs between trauma patients treated by experienced trauma surgeons versus novice surgeons.
- To determine if mortality improves for novice surgeons after the implementation of a structured trauma program with senior director mentorship.
Main Methods:
- Retrospective cohort study at an academic Level I trauma center.
- Compared mortality between experienced and novice surgeons concurrently over 5.5 years.
- Analyzed mortality in novice surgeons before and after program restructuring using chi-squared tests and logistic regression.
Main Results:
- No significant difference in mortality was found between novice and experienced trauma surgeons.
- Multivariate analysis revealed significantly improved mortality over time for patients treated by novice surgeons.
- Univariate analysis showed improvement in specific subgroups, including blunt trauma and emergency department survivors.
Conclusions:
- A structured trauma program with senior surgical mentorship negates the impact of individual surgeon inexperience on patient mortality.
- The overall system of care and mentorship are critical factors in improving trauma patient outcomes.
- The system effect appears to be more influential than the surgeon effect in this setting.
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