Identifying the Surgical to Nonsurgical Care Transition for Trauma Patients: Time to Redesign Trauma Workflow

IntroductionThe burden of traumatic injury in the United States continues to outpace the rate of trauma surgeons entering practice within a larger surgical workforce crisis. Furthermore, a trauma length of stay can be prolonged by many nonsurgical factors, including nonsurgical procedures, medical comorbidities, and socioeconomic barriers to discharge. We hypothesize that using a time-series analysis to predict the likelihood of surgeon-directed procedures can aid trauma centers in redesigning the trauma workflow and more efficiently deploying surgical resources.MethodsWe performed a single-institution, retrospective cohort study, including adult (≥18 years) trauma patients admitted to a level 1 trauma center between 2018 and 2022. Hospital billing and charge data were collected to determine procedure-level data. Procedures were classified as surgeon-directed or non-surgeon-directed. Probabilities were generated based on the likelihood of patients remaining hospitalized and requiring a surgeon-directed procedure.Results7382 patients underwent 3138 unique procedures. Of these patients, 6095 (82.6%) had at least one surgeon-directed procedure; 1287 (17.4%) had no surgeon-directed procedure. The length of stay was marginally longer in patients who underwent surgeon-directed procedures. For all patients, the likelihood of needing a surgeon-directed procedure declines each day of admission but stabilizes after day 5.ConclusionsIn our population, the surgical to nonsurgical transition during a trauma admission occurs after day 5. However, this may vary across institutions and not apply to patients requiring complex surgical intervention. Our methods can be used to structure and optimize the deployment of surgical resources only during the period with the highest surgical need.