Narayan Mayur, Tesoriero Ronald, Bruns Brandon R, Klyushnenkova Elena N, Chen Hegang, Diaz Jose J
Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
Division of Acute Care Surgery, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD.
J Am Coll Surg. 2015 Apr;220(4):762-70. doi: 10.1016/j.jamcollsurg.2014.12.051. Epub 2015 Jan 22.
Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC).
A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age.
There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p < 0.001). Among TCs, the effect was strongest for Level I TC (odds ratio = 0.34). For extreme APR_SOI, mortality was higher at TCs vs NTCs (p < 0.001).
Emergency general surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding.
急诊普通外科（EGS）是急性护理手术的一个主要组成部分，然而，关于创伤中心（TC）指定方面的死亡率数据有限。我们假设，与非创伤中心（NTC）相比，在创伤中心接受治疗的EGS患者死亡率会更低。
对2009年至2013年马里兰州医疗服务成本审查委员会数据库进行了回顾性研究。使用美国创伤外科协会的EGS ICD - 9编码来识别EGS患者。收集的数据包括人口统计学信息、创伤中心指定情况、急诊科入院情况以及所有患者病情严重程度细化指标（APR_SOI）。创伤中心指定被用作正式急性护理手术项目的一个标志。主要结局包括住院死亡率。进行了多变量逻辑回归分析，并对年龄进行了控制。
共有817942例EGS病例。患者的平均年龄±标准差为60.1±18.7岁，46.5%为男性；71.1%的病例在非创伤中心；75.8%为急诊科入院病例。总体死亡率为4.05%。根据创伤中心指定情况，在APR_SOI各分层中对年龄进行控制后计算死亡率。多变量逻辑回归分析显示，对于轻度APR_SOI，不同医院级别之间的死亡率无统计学显著差异。对于中度APR_SOI，创伤中心的死亡率显著低于非创伤中心（p<0.001）。在创伤中心中，一级创伤中心的影响最为显著（优势比=0.34）。对于极重度APR_SOI，创伤中心的死亡率高于非创伤中心（p<0.001）。
与非创伤中心相比，在创伤中心接受治疗的急诊普通外科患者在中度APR_SOI时死亡率较低，但在极重度APR_SOI时死亡率升高。需要进一步调查以更好地评估这一意外发现。
