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Area of Science:

  • Trauma Surgery
  • Healthcare Quality Improvement
  • Surgical Outcomes Research

Background:

  • The American College of Surgeons (ACS) currently verifies trauma centers (TCs) using annual trauma volume (ATV) alone.
  • This study investigates whether procedural volume (PV) offers a superior metric for assessing TC performance and patient outcomes.

Purpose of the Study:

  • To compare patient outcomes at ACS level I trauma centers stratified by annual trauma volume (ATV) versus procedural volume (PV).
  • To determine if PV is a better predictor of in-hospital mortality and major complications compared to ATV.

Main Methods:

  • A retrospective analysis of 2,218,425 patients treated at 182 ACS level I TCs from 2017-2021 using the ACS-TQIP database.
  • Centers were categorized into low, medium, and high volume tertiles based on both ATV and PV. PV included emergent laparotomies, thoracotomies, craniectomies/craniotomies, angioembolizations, and vascular repairs.
  • Multivariable regression analysis was employed to assess the independent association between volume metrics and outcomes, adjusting for confounders.

Main Results:

  • High procedural volume (PV) TCs demonstrated significantly lower mortality (3.7%) and major complication rates (3.1%) compared to low and medium PV TCs.
  • Conversely, high annual trauma volume (ATV) TCs showed higher mortality rates (4.5%), and medium ATV TCs had the highest major complication rates (5.3%).
  • Higher PV was independently associated with reduced odds of mortality and major complications after adjusting for confounders.

Conclusions:

  • Procedural volume (PV) is a superior predictor of improved patient outcomes at trauma centers compared to annual trauma volume (ATV).
  • Integrating PV into trauma center verification criteria could enhance the regionalization of trauma care, aligning resources with injury-specific patient needs.