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Hospital volume-outcome relationship in emergency trunk interventional radiology for trauma patients: a nationwide
Shogo Takashima1, Kazuma Yamakawa2, Ryo Hisamune1
1Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.
Objectives:
As with surgery, transcatheter arterial embolization is effective in managing arterial bleeding from trauma-related pelvic fractures and organ injuries. High-volume hospitals generally achieve better outcomes due to provider experience, but whether this applies to interventional radiology (IR) in trauma care remains unclear. This study examined whether hospitals with higher IR volumes improve outcomes for trauma patients.
Materials And Methods:
This retrospective cohort study used data on trauma patients undergoing emergency IR within the torso from the Japan Trauma Data Bank. Hospitals were categorized by annual emergency IR case volume: 1-6 (Category 1), 7-12 (Category 2), 13-18 (Category 3), 19-24 (Category 4), and > 24 cases (Category 5). The association between hospital volume and in-hospital mortality was analyzed with a mixed-effects logistic regression model adjusted for injury severity. Subgroup analyses conducted by dividing the 18-year study period into three intervals, 2004-2009, 2010-2015, and 2016-2021, assessed the time-related impact of volume on outcomes.
Results:
We analyzed 16,090 trunk-IR patients from 303 hospitals. In-hospital mortality rates were 16.2%, 13.9%, 14.3%, 13.1%, and 11.8% for Categories 1 to 5, respectively. Higher volumes of IR cases were associated with reduced mortality. When the annual case number was analyzed as a continuous variable, an increase of one was associated with decreased mortality (odds ratio = 0.988, 95% confidence interval = 0.982-0.994, p < 0.001). Subgroup analyses showed a significant association between higher volume and reduced mortality during 2004-2009 and 2010-2015, but not during 2016-2021.
Conclusion:
High-volume hospitals were associated with lower in-hospital mortality among patients undergoing emergency trunk IR.
Key Points:
Question The relationship between patient volume and clinical outcome is unknown for trauma patients undergoing emergency radiological interventions of the torso. Findings Higher hospital volumes of interventional radiology procedures performed in the trunk were associated with reduced in-hospital mortality. Clinical relevance Centralizing emergency interventional radiology cases, advancing trauma care education, and increasing awareness of interventional radiology can lead to better patient outcomes.
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