Less Is More: Dissecting Trauma Centers by Procedural Volume.

Area of Science:

• Trauma Surgery
• Surgical Quality Indicators
• Healthcare Management

Background:

• Annual trauma volume (ATV) is a key criterion for American College of Surgeons (ACS) Level I Trauma Center (TC) verification.
• The significance of procedural interventions as a quality indicator for TCs remains understudied.
• Understanding the relationship between patient volume and procedural complexity is crucial for TC assessment.

Purpose of the Study:

• To investigate the correlation between procedural volume and annual trauma volume (ATV) in ACS Level I TCs.
• To determine if ATV adequately represents the range and frequency of surgical procedures performed.
• To evaluate the concordance between different measures of trauma center workload.

Main Methods:

• Data from 182 ACS Level I TCs (2017-2021 ACS-TQIP) were analyzed.
• TCs were stratified by ATV (quartiles) and procedural volume (tertiles) for key interventions (laparotomy, thoracotomy, etc.).
• Cohen kappa statistic assessed the agreement between ATV and procedural volume stratification.

Main Results:

• Poor concordance was observed between ATV and procedural volumes across all analyzed interventions (e.g., laparotomy κ=0.270).
• High-volume procedural centers often fell into lower ATV categories, indicating a mismatch.
• Long bone fixation, laparotomy, and craniotomy/craniectomy were the most frequent procedures.

Conclusions:

• ATV alone is an insufficient metric for evaluating the procedural experience at trauma centers.
• A combined approach using both ATV and procedural volume data provides a more comprehensive assessment of a TC's clinical capabilities.
• Integrating procedural volume metrics can enhance the accuracy of TC verification and quality assessment.