"Halo effect" in trauma centers: does it extend to emergent colectomy?

Area of Science:

• Surgical outcomes research
• Emergency general surgery
• Health services research

Background:

• Trauma centers (TCs) improve outcomes for some non-trauma surgical conditions.
• It is unclear if TCs benefit all emergency general surgery (EGS) procedures.
• Emergent colectomy for diverticulitis serves as an index condition to evaluate TC effectiveness in EGS.

Purpose of the Study:

• To compare outcomes of emergent colectomy for diverticulitis between TCs and nontrauma centers (NTCs).
• To determine if TCs offer a survival or cost benefit for this specific EGS procedure.
• To investigate the generalizability of TC benefits to diverse EGS conditions.

Main Methods:

• Utilized the Nationwide Emergency Department Sample (2006-2011) for patients aged 16+ undergoing emergent colectomy for diverticulitis.
• Compared in-hospital mortality, total charges, and length of stay (LOS) between TCs and NTCs.
• Employed logistic regression and generalized linear models to adjust for patient, procedure, and hospital-level characteristics.

Main Results:

• A total of 25,396 patients were analyzed; 20.4% were treated at TCs.
• After adjustment, TCs showed significantly higher odds of mortality (OR, 1.23; P=0.003).
• Adjusted mean total charges and LOS were also significantly greater in TCs (P < 0.001).

Conclusions:

• The benefits of TCs observed for other non-trauma conditions were not replicated for emergent colectomy in diverticulitis patients.
• TCs were associated with increased mortality, charges, and LOS for this EGS procedure after risk adjustment.
• Further research is needed to explore case-mix differences and their impact on TC outcomes across EGS.