What price commitment: what benefit? The cost of a saved life in a developing level I trauma center.
BACKGROUND
In 1999, a Level I Trauma Center committed significant resources for development, recruitment of trauma surgeons, and call pay for subspecialists. Although this approach has sparked a national ethical debate, little has been published investigating efficacy. This study examines the price of commitment and outcomes at a Level I Trauma Center.


METHODS
Direct personnel costs including salary, call pay, and personnel expenses were analyzed against outcomes for two periods defined as PRE (1994-1999) and POST (2000-2005). Patient care costs and 1999 to 2000 transition data were excluded. Demographics, outcomes, and direct personnel costs were compared. Significant mortality reductions stratified by age and injury severity score (ISS) were used to calculate lives saved in relation to direct personnel costs. Student's t test and chi were used (significance *p < 0.05).


RESULTS
In the PRE period, there were 7,587 admissions compared with 11,057 POST. There were no significant differences PRE versus POST for age (41.4 +/- 24.4 years vs. 41.3 +/- 24.9 years), gender (62.4% vs. 63.7% male), mechanism of injury (11.5% vs. 11.8% penetrating), and percent intensive care unit admissions (30.1 vs. 29.9). Significant differences were noted for ISS (10.5 +/- 9.7 vs. 11.6 +/- 10.1*), percent admissions with ISS >or=16 (18.5 vs. 27.3*), and revised trauma score (10.8 +/- 2.8 vs. 10.7 +/- 2.8*). Both the average length of stay (6.8 +/- 8.8 vs. 6.5 +/- 9.8*) and percent mortality for ISS >or=16 (23 vs. 17*) were reduced. When mortality was stratified by both age and ISS, significant reductions were noted and a total of 173 lives were saved as a result. However, direct personnel costs increased from $7.6 million to $22.7 million. When cost is allocated to lives saved; the cost of a saved life was more than $87,000.


CONCLUSIONS
Resources for program development, including salary and call pay, significantly reduced mortality. Price of commitment: $3 million per year. The cost of a saved life: $87,000. The benefit: 173 surviving patients who would otherwise be dead.
Rotondo
Michael F
MF
Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27834,08, USA.
Bard
Michael R
MR
Sagraves
Scott G
SG
Toschlog
Eric A
EA
Schenarts
Paul J
PJ
Goettler
Claudia E
CE
Newell
Mark A
MA
Robertson
Matthew J
MJ
D000328:Adult; D003284:Contract Services / Q000191:economics; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D016730:Program Development; D012189:Retrospective Studies; D012456:Salaries and Fringe Benefits; D014193:Trauma Centers / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D014194:Traumatology / Q000191:economics; D000078329:Workforce; D014947:Wounds and Injuries / Q000191:economics* / Q000401:mortality*; D055815:Young Adult