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Cited by 39Trauma and Emergency Care StudiesHospital Admissions and OutcomesEmergency and Acute Care Studies

High-volume hospitals are associated with lower mortality among high-risk emergency general surgery patients

Ogola, Gerald O., Crandall, Marie L., Richter, Kathleen M., Shafi, Shahid·2018·Journal of Trauma and Acute Care Surgery
DOI 10.1097/ta.0000000000001985
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Abstract

INTRODUCTION: We have previously demonstrated that Emergency General Surgery (EGS) patients treated at high-volume hospitals experience lower mortality rates than those treated at low-volume hospitals. However, EGS comprises a wide spectrum of diseases. Our goal was to determine which EGS diseases had better outcomes at high-volume hospitals. METHODS: We undertook a retrospective analysis of the National Inpatient Sample database for 2013 (a nationwide representative sample). Patients with EGS diseases were identified using American Association for the Surgery of Trauma definitions. A hierarchical logistic regression model was used to measure risk-adjusted probability of death, adjusting for age, sex, race, ethnicity, insurance type, and comorbidities. Patients were then grouped into 16 risk groups based upon their predicted probability of death. We then compared observed mortality rates at high- versus low-volume hospitals within each risk group. RESULTS: Nationwide, 3,006,615 patients with EGS diseases were treated at 4,083 hospitals in 2013. Patients with predicted risk of death of 4% or higher (275,615 patients, 9.2%) had lower observed mortality rates at high-volume hospitals than at low-volume hospitals (7.7% vs. 10.2%, p < 0.001). We estimated that 1,002 deaths were potentially preventable if high-risk patients who were treated at low-volume hospitals were instead transferred to high-volume hospitals. CONCLUSION: EGS patients with predicted risk of death of 4% or higher experience lower mortality rates at high-volume hospitals than at low-volume hospitals. A regional system of EGS care that enables rapid transfer of high-risk patients to high-volume hospitals may prevent several deaths. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III; Therapeutic/Case Management, level IV.

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  • For complex emergency general surgical conditions that pose an immediate threat to life, studies have demonstrated improved outcomes at high-volume, tertiary centers with advanced clinical resources such as immediate operating room capabilities, interventional radiology procedures, and intensive care unit availability.

    “For complex Emergency General Surgical (EGS) conditions that pose an immediate threat to life, studies have demonstrated improved outcomes at high-volume, tertiary centers with advanced clinical resources such as immediate operating room capabilities, interventional radiology procedures, and intensive care unit (ICU) availability.”

    From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [3]

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Authors
Ogola, G. O., Crandall, M. L., Richter, K. M., & Shafi, S.
Affiliations
University of Florida (US)
ORCID
Venue
Journal of Trauma and Acute Care Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-09
Volume
85
Issue
3
Pages
560-565
ISSN
  • 2163-0755 (ISSN-L)
  • 2163-0763
DOI
10.1097/ta.0000000000001985
OpenAlex
W2804222829
Cited by
39
References
20
Citations by year
2026: 3 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 11 · 2020: 6 · 2019: 2
FWCI
5.80
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
emergency general surgery, hospital volume, mortality, high-risk patients, risk-adjusted mortality, patient transfer, trauma outcomes
MeSH terms
Adult, Aged, Aged, 80 and over, Emergencies, Emergency Medical Services, Female, Humans, Male, Middle Aged, Mortality, Retrospective Studies, United States, Comorbidity, Hospital Mortality, Hospitals, High-Volume

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