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20-03-2012 | Surgery | Article

Quality of care for trauma and EMGS patients unequal


Free abstract

MedWire News: Trauma patients receive a better quality of care than emergency general surgery (EMGS) patients, despite the overlap in personnel and resources, say researchers.

Results of a study published in the Archives of Surgery show there is a lack of correlation between the quality of care provided to the patients of the two services, and suggest that well-established trauma performance improvement (PI) programs may explain the difference.

"Although these areas of surgery are currently served by 2 independent PI programs, the relationship between the hospital-level outcomes across these surgical fields is of particular interest due to evolution of the acute care surgery paradigm… With the development of acute care surgery and the trend towards surgical subspecialization, trauma surgeons are increasingly functioning as acute care surgeons and caring for trauma and emergency general surgery patients," write Angela Ingraham (University of Cincinnati, Ohio, USA) and colleagues.

Ingraham and team compared hospital performance in trauma and EMGS care, and in trauma and elective general surgery (ELGS), in 46 hospitals. Their study included 32,557 trauma patients and 134,495 general surgery patients, the latter consisting of10.6% EMGS and 89.4% ELGS patients.

Crude mortality was 7.5% for trauma patients, 6.6% for EMGS patients, and 1.4% for ELGS patients. Crude serious morbidity (such as systemic sepsis, pulmonary embolism, acute respiratory distress syndrome in the trauma patients, or surgical site infection, wound dehiscence, and septic shock in the EMGS/ELGS patients) was 10.7% for trauma patients, 16.2% for EMGS patients, and 6.1% for ELGS patients. There were no significant relationships between trauma and EMGS mortality or morbidity, or between trauma and ELGS mortality or morbidity.

The researchers suggest a number of explanations regarding the lack of relationship between trauma and general surgical outcomes. First, hospital-level quality improvement initiatives may be procedure-specific and so not benefit all patient groups equally. Second, they say it may be due to the fact that acute care surgery services have only recently been formally developed and implemented whereas PI programs have long existed for trauma centers.

"The lack of an association between trauma and emergency general surgery outcomes has significant implications for quality improvement in these areas and may lead to the development of quality improvement programs that follow the model of trauma," say Ingraham and co-workers.

The acute care surgery model is an initiative to combine the specialty of trauma with the field of emergency general surgery," writes Mark Hemmila of the University of Michigan in Ann Arbor, USA, in an invited commentary. "In reality, emergency general surgery care is extremely vast in how it is delivered, with thousands of hospitals engaged in treating patients throughout the country… I suspect that enactment of rigorous quality improvement at many trauma centers, beyond the arena of trauma patients, is likely still in its infancy. Hence, a potential reason for the negative findings of this study."

By Chloe McIvor

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