THE EPIDEMIOLOGY OF EMERGENCY DEPARTMENT THORACOTOMY IN A STATEWIDE TRAUMA SYSTEM: DOES CENTER VOLUME MATTER?

Introduction The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. Materials and Methods We queried the Pennsylvania Trauma Outcomes Study (PTOS) registry from 2007-2015 for all EDTs performed at level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. Results 1,399 emergency department thoracotomies were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared to patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). Conclusions Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared to those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower volume centers. Study type Level 3: Retrospective cohort study Corresponding author and requests for reprint requests: Ryan P. Dumas, MD, Department of Surgery, University of Pennsylvania School of Medicine, 51 N 39th St, MOB building 1st floor, Philadelphia PA 19104. ryan.dumas@uphs.upenn.edu Conflicts of Interest and Source of Funding: No authors have conflicts to declare. DNH is currently supported by a training grant through the National Heart, Lung, and Blood Institute. (K08HL131995) Meetings at which this was presented: 47th World Surgical Congress, August 13-17, 2017, Basel Switzerland. © 2018 Lippincott Williams & Wilkins, Inc.

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