Operative Trauma and Mortality: The Role of Volume

Area of Science:

• Trauma Surgery
• Surgical Outcomes Research
• Public Health

Background:

• Operative volume is a known predictor of improved outcomes in various surgical fields.
• The relationship between operative volume and outcomes in trauma surgery, specifically for hemorrhage control, requires further elucidation.
• This study investigates the association between surgical case volume and patient mortality in trauma care.

Purpose of the Study:

• To determine the association between operative trauma volume and in-hospital mortality.
• To test the hypothesis that increased operative volume leads to improved survival rates in trauma patients undergoing hemorrhage control surgery.

Main Methods:

• Utilized data from the National Trauma Data Bank (2017-2020).
• Included adult patients (≥18 years) undergoing hemorrhage control surgery at Level I or II trauma centers.
• Employed hierarchical logistic regression to analyze the relationship between operative volume and mortality, controlling for patient demographics and clinical factors.

Main Results:

• Analysis of 55,469 patients across 516 trauma centers revealed a significant association between higher operative volume and reduced in-hospital mortality (OR 0.999).
• However, a subset analysis excluding the busiest 5% of centers showed operative volume became non-significant, indicating the mortality benefit is driven by extremely high-volume centers.
• Significant variability in annual operative volumes was observed, with the top 5% of centers performing substantially more cases than the middle 50%.

Conclusions:

• While higher operative trauma volume is linked to decreased mortality in hemorrhage control surgery, this benefit is primarily observed in very high-volume centers.
• The practicalities of centralizing time-sensitive hemorrhage control surgery at such high-volume centers are challenging.
• Future research should explore patient proximity to trauma centers, center volume, and identify modifiable factors from high-volume centers for broader implementation.