title: National variation in outcomes and costs for splenic injury and the impact of trauma systems: a population-based cohort study.
abstract: OBJECTIVE
  To measure national variation in splenectomy rates, mortality, and costs for hospitalized patients with splenic injury and the impact of state trauma systems on these outcomes.
  
  
  METHODS
  Using the HCUP State Inpatient Database for 2001, 2004, and 2007, all patients hospitalized with splenic injury were identified from 19 participating states. Multivariate regression was performed to compare splenectomy rates, inpatient mortality, and costs between states. Inclusiveness of statewide trauma systems was categorized based on the proportion of hospitals designated as a trauma center.
  
  
  RESULTS
  Of 33,131 patients, 26.2% underwent splenectomy, 6.1% died, and median hospital costs were $14,317. After adjusting for patient, injury, and hospital characteristics, there was a 1.7-fold variation (RR 1.67; 95% CI, 1.39-2.01) among the 19 states in rates of splenectomy. Adjusted inpatient mortality varied more than 2-fold between the highest and lowest states (RR 2.43; 95% CI, 1.76-3.37). Adjusted hospital costs varied over 60% between the highest and lowest states (cost ratio 1.61; 95% CI, 1.41-1.83). States with the most inclusive trauma systems had significantly lower splenectomy rate (RR 0.79; 95% CI, 0.68-0.92) and lower mortality (RR 0.71; 95% CI, 0.58-0.87), but similar hospital costs (CR 1.05; 95% CI, 0.95-1.16) compared to states with exclusive or no trauma systems.
  
  
  CONCLUSIONS
  Significant geographic variation in the management, outcome, and costs for splenic injury exists in the United States, and may reflect differences in quality of care. Inclusive trauma systems seem to improve outcomes without increasing hospital costs.
authors.affiliation: Harborview Injury Prevention and Research Center, Department of Surgery, University of Washington and Harborview Medical Center, Seattle, WA, USA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Hamlat
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Koepsell
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000007:Abdominal Injuries / Q000191:economics* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy / Q000191:economics* / Q000401:mortality* / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review; D014949:Wounds, Nonpenetrating / Q000191:economics* / Q000401:mortality*; D055815:Young Adult