title: Effect of trauma center status on 30-day outcomes after emergency general surgery.
abstract: BACKGROUND
  Trauma surgeons increasingly care for emergency general surgery (EGS) patients. The extent to which trauma center (TC) performance improvement translates into improved quality for EGS is unknown. We hypothesized that EGS outcomes in TCs would be similar to outcomes in non-trauma centers (NTC); failure to support our hypothesis suggests that the effects of trauma performance improvement have extended beyond trauma patients.
  
  
  METHODS
  We retrospectively studied EGS procedures at TCs versus NTCs among American College of Surgeons National Surgical Quality Improvement Program participants (2005-2008). Thirty-day outcomes were overall morbidity, serious morbidity, and mortality. TC versus NTC outcomes were compared using regression modeling, observed-to-expected (O/E) ratios (among hospitals submitting ≥20 EGS procedures), and outlier status (hospitals whose O/E confidence interval excludes 1.0).
  
  
  RESULTS
  Of 68,003 patients at 222 hospitals, 42,264 (62.2%) were treated at 121 TCs; 25,739 (37.8%) were treated at 101 NTCs. TCs had significantly higher overall morbidity (21.4% versus 17.2%; p < 0.0001), serious morbidity (15.8% versus 12.3%; p < 0.0001), and mortality (6.4% versus 4.8%; p < 0.0001) than NTCs. On adjusted analyses, TC status was a significant predictor of overall morbidity (odds ratio = 1.11; 95% CI, 1.01-1.21), but not serious morbidity (odds ratio = 1.08; 95% CI, 0.98-1.19) or mortality (odds ratio = 0.92; 95% CI, 0.82-1.04). Among 211 hospitals assigned O/E ratios, TCs were more likely, although not significantly so, to be high outliers for overall morbidity (7.6% versus 4.3%; p = 0.017), serious morbidity (5.1% versus 4.3%; p = 0.034), and mortality (3.4% versus 2.2%; p > 0.099).
  
  
  CONCLUSIONS
  Although overall morbidity tended to favor NTCs, mortality was no different. This suggests that the trauma performance improvement processes have not been applied to EGS patients, despite being cared for by similar providers. Despite having processes for trauma, there remains the opportunity for quality improvement for EGS care.
authors.affiliation: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA. aingraham@facs.org
authors.forename: Angela M
authors.initials: AM
authors.lastname: Ingraham
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D004630:Emergencies; D005260:Female; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States