Outcomes by time-to-OR for penetrating abdominal trauma patients

Area of Science:

• Trauma Surgery
• Healthcare Quality Improvement
• Process Measurement

Background:

• Time-to-OR is a widely used process measure in trauma care.
• Its direct impact on patient mortality and complication rates remains debated.
• Existing evidence does not consistently link faster facility times to better outcomes.

Purpose of the Study:

• To evaluate the association between facility-level Time-to-OR speed and patient mortality.
• To determine the impact of individual patient Time-to-OR on mortality and complications.
• To assess the relationship between Time-to-OR and outcomes in penetrating abdominal trauma and firearm injuries.

Main Methods:

• Utilized the Trauma Quality Improvement Program (TQIP) database.
• Categorized hospitals into slow, average, and fast based on the 75th percentile Time-to-OR.
• Employed Generalized Estimating Equations (GEE) to analyze mortality odds at facility and patient levels.

Main Results:

• Facility speed was not significantly associated with mortality for all penetrating trauma or firearm-only patients.
• Each additional minute of Time-to-OR at the patient level was associated with decreased odds of in-hospital mortality (OR 0.985).
• Failure-to-rescue analysis showed no difference in mortality by facility speed but a decrease in mortality with increased patient-level Time-to-OR.

Conclusions:

• Current Time-to-OR metrics at the facility level show limited evidence of improving trauma patient outcomes.
• Individual patient Time-to-OR demonstrates a statistically significant association with reduced in-hospital mortality.
• Development of trauma performance metrics that better reflect patient outcomes is recommended.