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Association Between Congenital Heart Disease-Related Diagnosis Codes and Trauma Surgery Outcomes
Titilola Babatunde1, Seth Wolf2,3, Dmitry Tumin4,5
1Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Insights
Congenital heart disease (CHD) in trauma patients is linked to worse outcomes, including less home discharge and longer hospital stays. Documenting CHD as a comorbidity is crucial for better trauma care planning.
Area of Science:
- Trauma Surgery
- Cardiology
- Public Health
Background:
- Congenital heart disease (CHD) affects 8-10 per 1000 live births.
- CHD is a known risk factor for adverse outcomes in non-cardiac surgery.
- The risk of CHD in trauma surgery is not well-established.
Purpose of the Study:
- To determine if documented CHD diagnoses correlate with adverse outcomes in trauma surgery.
- To analyze the association between CHD comorbidity and surgical outcomes in trauma patients.
Main Methods:
- Utilized 2010-2019 American College of Surgeons Trauma Quality Programs data.
- Included trauma patients of all ages undergoing surgery with at least one comorbidity code.
- Stratified patients by CHD-related comorbidity codes versus other comorbidities.
Main Results:
- Matched 215 CHD cases with 215 non-CHD controls using propensity scores.
- Patients with CHD were less likely to be discharged home (OR 0.44, P=.005).
- CHD patients experienced prolonged hospital length of stay (IRR 1.06, P=.046).
Conclusions:
- This study is the first quantitative analysis linking comorbid CHD diagnoses to increased adverse outcomes in trauma surgery.
- Routine documentation of CHD as a comorbidity in trauma admissions is recommended.
- Trauma centers should prepare for patients with potential CHD comorbidities.
Background:
Congenital heart disease (CHD) is one the most common congenital anomalies, with a prevalence of 8-10 cases per 1000 live births in the United States. Congenital heart disease has been recognized as a risk factor for poor perioperative and postoperative outcomes in non-cardiac surgery. We aimed to determine if documentation of CHD-related diagnosis codes was associated with similar risks for trauma surgery.
Methods:
Data were acquired from the 2010-2019 American College of Surgeons' Trauma Quality Programs Participant Use Files. This study included trauma patients of all ages with one or more surgical procedures and at least one documented non-trauma (comorbidity) International Classification of Diseases code. Patients were stratified based on presence of CHD-related comorbidity codes vs any other comorbidity. Outcomes included mortality, hospital length of stay (LOS), discharge disposition, and in-hospital complications.
Results:
Using 1:1 propensity score matching, we matched 215 cases with CHD-related comorbid diagnoses to non-CHD controls. Compared to patients with other comorbidities, patients with CHD-related comorbidites were less likely to be discharged home to self-care (odds ratio: 0.44, 95% confidence interval [CI]: 0.25, 078 P = .005) and tended to have prolonged hospital LOS (incidence rate ratio [IRR]: 1.06, 95% CI: 1.001, 1.13, P = .046).
Conclusions:
We present the first quantitative multicenter analysis correlating documentation of comorbid CHD-related diagnoses with higher risk of adverse outcomes after trauma surgery. These results support the need to routinely acknowledge and document CHD as comorbidity in trauma admissions that could lead to surgical intervention and for trauma centers to prepare for patients with a possible CHD comorbidity.
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