TY - JOUR
T1 - Injured patients have lower mortality when treated by "full-time" trauma surgeons vs. surgeons who cover trauma "part-time"
AU - Haut, Elliott R.
AU - Chang, David C.
AU - Efron, David T.
AU - Cornwell, Edward E.
PY - 2006/8
Y1 - 2006/8
N2 - BACKGROUND: Studies examining the effect of trauma surgeon volume on patient outcomes have had disparate results. We hypothesize that "full-time" trauma surgeons would have lower patient mortality rates than surgeons covering trauma "part-time." METHODS: Retrospective review of 14,171 patients during a span of 6.5 years (January 1998 to June 2004) from the trauma registry at an urban, university-based Level I trauma center. "Full-time" surgeons practiced primarily trauma, emergency surgery, and critical care. "Part-time" surgeons took trauma call, but mainly practiced another type of surgery (e.g., pancreatic, hepatobiliary, vascular, transplant). Chi square and multiple logistic regression compared mortality between groups. RESULTS: There were no differences in patient demographics or admission injury patterns between the two groups. On bivariate analysis, the subgroup of patients with severe head injury had lower mortality when treated by "full-time" surgeons. With ED deaths excluded, more severely injured patients (Injury Severity Score [ISS] >15) had a survival benefit in the "full-time" group. Multiple logistic regression showed a 50% increase in mortality for patients treated by "part-time" trauma surgeons when adjusting for age, sex, ISS >15, severe head injury, hypotension, nighttime admission, day of the week, and penetrating mechanism (odds ratio of death 1.45, 95% CI 1.04-2.02). Similar results are seen in only patients surviving to emergency room discharge (odds ratio of death 1.50, 95% CI 1.01-2.22). Z and W scores showed higher than expected survival for all patients with the "full-time" cohort showing a larger benefit. CONCLUSIONS: Even within an established trauma program treating many injured patients, mortality is significantly lower in patients initially treated by "full-time" trauma surgeons.
AB - BACKGROUND: Studies examining the effect of trauma surgeon volume on patient outcomes have had disparate results. We hypothesize that "full-time" trauma surgeons would have lower patient mortality rates than surgeons covering trauma "part-time." METHODS: Retrospective review of 14,171 patients during a span of 6.5 years (January 1998 to June 2004) from the trauma registry at an urban, university-based Level I trauma center. "Full-time" surgeons practiced primarily trauma, emergency surgery, and critical care. "Part-time" surgeons took trauma call, but mainly practiced another type of surgery (e.g., pancreatic, hepatobiliary, vascular, transplant). Chi square and multiple logistic regression compared mortality between groups. RESULTS: There were no differences in patient demographics or admission injury patterns between the two groups. On bivariate analysis, the subgroup of patients with severe head injury had lower mortality when treated by "full-time" surgeons. With ED deaths excluded, more severely injured patients (Injury Severity Score [ISS] >15) had a survival benefit in the "full-time" group. Multiple logistic regression showed a 50% increase in mortality for patients treated by "part-time" trauma surgeons when adjusting for age, sex, ISS >15, severe head injury, hypotension, nighttime admission, day of the week, and penetrating mechanism (odds ratio of death 1.45, 95% CI 1.04-2.02). Similar results are seen in only patients surviving to emergency room discharge (odds ratio of death 1.50, 95% CI 1.01-2.22). Z and W scores showed higher than expected survival for all patients with the "full-time" cohort showing a larger benefit. CONCLUSIONS: Even within an established trauma program treating many injured patients, mortality is significantly lower in patients initially treated by "full-time" trauma surgeons.
KW - Fulltime
KW - Mortality
KW - Outcomes
KW - Part-time
KW - Trauma surgeon
KW - Trauma systems
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U2 - 10.1097/01.ta.0000222939.51147.1c
DO - 10.1097/01.ta.0000222939.51147.1c
M3 - Article
C2 - 16917439
AN - SCOPUS:33747618715
SN - 0022-5282
VL - 61
SP - 272
EP - 278
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 2
ER -