N. Nagarajan1, S. Selvarajah1, H. Alshaikh1, F. Gani1, H. Alturki1, A. Najafian1, C. K. Zogg1, D. T. Efron1, E. B. Schneider1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA
Introduction: Trauma Centers (TC) have been shown to have a “halo effect”, resulting in improved outcomes for non-trauma conditions. It remains unclear if these improvements extend to outcomes for emergency general surgery (EGS). Using emergent colectomy in patients with diverticulitis as an index condition, the objective of this study was to compare outcomes between TC and NTC.
Methods: The Nationwide Emergency Department Sample (2006-2011) was queried for patients (≥16 years) who underwent an emergent colectomy (ICD9: 173*, 457*, 458*) with a primary diagnosis of diverticulitis (ICD9: 562.11, 562.13). Outcomes studied included mortality, total charges (in 2011 dollars) and length of stay (LOS). Mortality in TC and NTC was compared using logistic regression, controlling for age, sex, Charlson Comorbidity Index (CCI), type of insurance, income quartile, partial/total colectomy, presence of peritonitis, perforation, and hospital region, clustering by hospital. Unadjusted total charges and LOS were analyzed with non-parametric tests, then were adjusted for all of the above and mortality. Adjusted total charges and LOS were analyzed using generalized linear models with gamma and Poisson distributions, respectively.
Results: A total of 25,396 patients were included; of whom 5,189 (20.4%) were treated at TC and 20,207 (79.6%) at NTC. Median age [60 years (IQR: 49-73), p = 0.959] and proportion of females (51.6% vs. 51.3%, p = 0.395) were similar between TC and NTC, but there were significant differences in insurance status (p = 0.027) and median household income (p <0.001) (Table I). Unadjusted mortality at TC did not significantly differ from NTC, median charges and were significantly different (Table I). After controlling for patient, procedure and hospital-level characteristics, the odds of mortality was significantly higher in TC (OR=1.24, 95% CI, 1.02-1.51). Estimated mean charges ($127,801 vs. $116,464, p = 0.004) and LOS (IRR=1.06, 95% CI, 1.05-1.11) were also significantly higher in TC after adjustment.
Conclusion: The improved outcomes reported for other non-trauma conditions in TC were not observed for patients undergoing an emergent colectomy for diverticulitis after accounting for demographic and hospital-level characteristics. Future research is needed to discern if differences in the clinical course of patients in TC compared to those in NTC are affecting our findings.
