Trauma surgeons increasingly care for emergency general surgery (EGS) patients. The extent to which trauma center (TC) performance improvement translates into improved quality for EGS is unknown. We hypothesized that EGS outcomes in TCs would be similar to outcomes in non-trauma centers (NTC); failure to support our hypothesis suggests that the effects of trauma performance improvement have extended beyond trauma patients.
We retrospectively studied EGS procedures at TCs versus NTCs among American College of Surgeons National Surgical Quality Improvement Program participants (2005-2008). Thirty-day outcomes were overall morbidity, serious morbidity, and mortality. TC versus NTC outcomes were compared using regression modeling, observed-to-expected (O/E) ratios (among hospitals submitting =20 EGS procedures), and outlier status (hospitals whose O/E confidence interval excludes 1.0).
Of 68,003 patients at 222 hospitals, 42,264 (62.2%) were treated at 121 TCs; 25,739 (37.8%) were treated at 101 NTCs. TCs had significantly higher overall morbidity (21.4% versus 17.2%; p 0.099).
Although overall morbidity tended to favor NTCs, mortality was no different. This suggests that the trauma performance improvement processes have not been applied to EGS patients, despite being cared for by similar providers. Despite having processes for trauma, there remains the opportunity for quality improvement for EGS care.