title: Diverticulitis Outcomes are Equivalent Between Level 1 Trauma Centers and Community Hospitals in New Jersey.
abstract: Traditionally, general surgeons provide emergency general surgery (EGS) coverage by assigned call. The acute care surgery (ACS) model is new and remains confined mostly to academic centers. Some argue that in busy trauma centers, on-call trauma surgeons may be unable to also care for EGS patients. In New Jersey, all three Level 1 Trauma Centers (L1TC) have provided ACS services for many years. Analyzing NJ state inpatient data, we sought to determine whether outcomes in one common surgical illness, diverticulitis, have been different between L1TC and nontrauma centers (NTC) over a 10-year period. The NJ Medical Database was queried for patients aged 18 to 90 hospitalized from 2001 to 2010 for acute diverticulitis. Demographics, comorbidities, operative rates, and mortality were compiled and analyzed comparing L1TC to NTC. For additional comparison between L1TC and NTC, 1:1 propensity score matching with replacement was accomplished. χ(2), t test, and Cochran-Armitage trend test were used. From 2001 to 2010, 88794 patients were treated in NJ for diverticulitis. 2621 patients (2.95%) were treated at L1TCs. Operative rates were similar between hospital types. Patients treated at L1TCs were more often younger (63.1 ± 0.3 vs 64.7 ± 0.1; P < 0.001), nonwhite (43.1% vs 23.1%; P < 0.0001), and uninsured (11.0% vs 5.5%; P < 0.0001). After propensity matching, neither operative mortality (9.7% vs 7.9% P = 0.45), nor nonoperative mortality (1.2% vs 1.3% P = 0.60) were different between groups. Mortality and operative rates for patients with acute diverticulitis are equivalent between LT1C and NTC in NJ. Trauma centers in NJ more commonly provide care to minority and uninsured patients.
authors.affiliation: Department of Surgery, Trauma Services, East Texas Medical Center, Tyler, Texas, USA.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Gale
authors.forename: Dena
authors.initials: D
authors.lastname: Arumugam
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004238:Diverticulitis / Q000208:ethnology / Q000401:mortality* / Q000601:surgery*; D004630:Emergencies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009515:New Jersey; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American