Comparison of Hospital Performance in Trauma vs Emergency and Elective General Surgery Implications for Acute Care Surgery Quality Improvement

Hypotheses: As emergency general surgery (EMGS) and trauma care are increasingly being provided by the same personnel with overlapping resources, we postulated that the quality of care provided to EMGS and trauma patients would be similar. We also evaluated the relationship between trauma and elective general surgery (ELGS) care, believing that performance would be similar across these services as it reflects institutional culture. Design: Retrospective cohort study comparing hospital performance in trauma and EMGS care and in trauma and ELGS care. Regression models for mortality and serious morbidity were constructed for trauma, EMGS, and ELGS hospitals contributing to both the National Trauma Data Bank (2007) and American College of Surgeons National Surgical Quality Improvement Program (2005-2008). Setting: Forty - six hospitals. Main Outcome Measures: Correlations of observed to expected ratios were examined. Outlier status (hospitals with CIs of observed to expected ratios excluding 1.0) was compared using weighted kappa. Results: There was no significant relationship between trauma and EMGS mortality (r=-0.01, P=.94; kappa=-0.10, P=.61) or between trauma and ELGS mortality (r=0.23, P=.12; kappa=0.07, P=.62). There was no significant relationship between trauma and EMGS morbidity (r=0.21, P=.17; kappa=0.04, P=.63) or between trauma and ELGS morbidity (r=0.16, P=.30; kappa=0.11, P=.37). No hospitals were consistently low or high outliers across all 3 groups. Conclusions: Trauma performance improvement programs are well established compared with those for EMGS. Although EMGS patients use similar structures and processes as trauma patients, there is a lack of correlation between the quality of care provided to trauma and EMGS patients; EMGS should be incorporated into trauma performance improvement programs.