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Abstract

Background

Trauma is a leading cause of global death, with 200 000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System.

Methods

Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS.

Results

41,927 trauma evaluations were performed, leading to 16 044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7 Kg/m², respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages.

Conclusions

The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

Keywords

surgical outcomes value quality laparotomy thoracotomy

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References

Corso

Finkelstein

Miller

Fiebelkorn

Zaloshnja

. Incidence and lifetime costs of injuries in the United States. Inj Prev. 2015;21(6):434-440.

Rossiter

. Trauma-the forgotten pandemic? Int Orthop. 2022;46(1):3-11.

Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222.

Lee

Kawamoto

Hess

, et al. Implementation of a value-driven outcomes program to identify high variability in clinical costs and outcomes and association with reduced cost and improved quality. Jama. 2016;316(10):1061-1072.

Porter

. What is value in health care? N Engl J Med. 2010;363(26):2477-2481.

Sultan

. Finding the path toward fee-for-value. Health Manag Technol. 2015;36(7):24.

Clavien

Barkun

de Oliveira

, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-196.

MacLeod

JBA

Kobusingye

Frost

Lett

Kirya

Shulman

. A comparison of the Kampala trauma score (KTS) with the revised trauma score (RTS), injury severity score (ISS) and the TRISS method in a Ugandan trauma registry: is equal performance achieved with fewer resources? Eur J Trauma. 2003;29:392-398.

Palmer

. Major trauma and the injury severity score--where should we set the bar? Annu Proc Assoc Adv Automot Med. 2007;51:13-29.

10.

Downey

Zun

Burke

Jefferson

. Who pays? How reimbursement impacts the emergency department. J Health Hum Serv Adm. 2014;36(4):400-416.

11.

Arora

Moriates

Shah

. The challenge of Understanding health care costs and charges. AMA J Ethics. 2015;17(11):1046-1052.

12.

Analysis UDoCBoE . Previously Published Estimates of National Accounts (NIPA) - Section 1: Domestic Product and Income. Gross Domestic Product | U.S. Bureau of Economic Analysis (BEA); 2021.

13.

Bilimoria

Liu

Paruch

, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833-842.

14.

Fredrickson

Carver

. Trauma-related electrolyte disturbances: from resuscitation to rhabdomyolysis. Nutr Clin Pract. 2022;37(5):1004-1014.

15.

Ylimartimo

Koskela

Lahtinen

Kaakinen

Vakkala

Liisanantti

. Outcomes in patients requiring intensive care unit (ICU) admission after emergency laparotomy: a retrospective study. Acta Anaesthesiol Scand. 2022;66(8):954-960.

16.

Fujii

Shirakawa

Nakamura

Baba

Hitosugi

. Factors influencing the injury severity score and the probability of survival in patients who fell from height. Sci Rep. 2021;11(1):15561.

17.

Ringdal

Skaga

Steen

, et al. Classification of comorbidity in trauma: the reliability of pre-injury ASA physical status classification. Injury. 2013;44(1):29-35.

18.

Fitch

CJL

Albini

Patel

, et al.

Blunt versus penetrating trauma: is there a resource intensity discrepancy?

Am J Surg. 2019;218(6):1201-1205.

19.

Obirieze

Gaskin

Villegas

, et al.

Regional variations in cost of trauma care in the United States: who is paying more?

J Trauma Acute Care Surg. 2012;73(2):516-522.

20.

Fortune

Wohltmann

Margold

Callahan

Sutyak

. Maximizing reimbursement from trauma response fees (UB-92: 68X) - lessons learned from a hospital comparison. J Trauma. 2005;58(3):482-486.

21.

Peng

Anton

Cha

, et al. Objective measures of communication behavior predict clinical performance. J Surg Educ. 2019;76(5):1337-1347.

22.

Chapman

Liljas

Neumann

, et al. Measuring costs in cost-utility analyses: variations in the literature. International Journal of Technology Assessment in Health Care. 2000;16(1):111-124.

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Trauma Program Value Assessment at an Academic Health Network System Over 12 Years