Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study
Background Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter‐hospital variation in surgical intensity for injury admissions and...
Gespeichert in:
| Veröffentlicht in: | International journal of clinical practice (Esher) 2020-11, Vol.74 (11), p.e13613-n/a |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | n/a |
|---|---|
| container_issue | 11 |
| container_start_page | e13613 |
| container_title | International journal of clinical practice (Esher) |
| container_volume | 74 |
| creator | Patton, Marie‐Pier Moore, Lynne Farhat, Imen Tardif, Pier‐Alexandre Gonthier, Catherine Belcaid, Amina Lauzier, François Turgeon, Alexis Clément, Julien |
| description | Background
Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter‐hospital variation in surgical intensity for injury admissions and evaluate the correlation between hospital surgical intensity and mortality/complications.
Methods
We included adults admitted for major trauma between 2006 and 2016 in a Canadian provincial trauma system. Analyses were stratified for orthopaedic (n = 16 887), neurological (n = 12 888) and torso injuries (n = 9816). Surgical intensity was quantified with the number of surgical procedures |
| doi_str_mv | 10.1111/ijcp.13613 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2425591786</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2425591786</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3933-dc70e425e8e2b9b4ebca09aa817c5512e831b1790f117b4b83ecad644cfed2553</originalsourceid><addsrcrecordid>eNp90Mtq3DAUBmBRWjqTyyYPUATdhIBTHcuy7OzCkMuUQLtI1kaWjxMNtuVKcot3eYQ-Y5-kSpx0kUW1kRAfP-f8hBwBO4V4vpidHk-B58DfkTXILE0gzeB9fPO8SATjsCJ73u8YS4Uo2Eey4mlecMnZmtTbIaD78_j7wfrRBNXRn8oZFYwdqBmon9y90fHXRDZ4E2baWkeDU1OvqGp6432k_oye037qgtE4BIdU2wfrAvVhauYD8qFVncfDl3uf3F1e3G6uk5tvV9vN-U2iecl50mjJMEsFFpjWZZ1hrRUrlSpAaiEgxYJDDbJkLYCss7rgqFWTZ5lusYmL8X1yvOSOzv6Y0IcqTqex69SAdvJVGsNFCbLII_38hu7s5IY4XVQCRCYZyKhOFqWd9d5hW43O9MrNFbDqqfnqqfnqufmIP71ETnWPzT_6WnUEsIBfpsP5P1HV9uvm-xL6F7nckB8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2451547017</pqid></control><display><type>article</type><title>Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Patton, Marie‐Pier ; Moore, Lynne ; Farhat, Imen ; Tardif, Pier‐Alexandre ; Gonthier, Catherine ; Belcaid, Amina ; Lauzier, François ; Turgeon, Alexis ; Clément, Julien</creator><creatorcontrib>Patton, Marie‐Pier ; Moore, Lynne ; Farhat, Imen ; Tardif, Pier‐Alexandre ; Gonthier, Catherine ; Belcaid, Amina ; Lauzier, François ; Turgeon, Alexis ; Clément, Julien</creatorcontrib><description>Background
Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter‐hospital variation in surgical intensity for injury admissions and evaluate the correlation between hospital surgical intensity and mortality/complications.
Methods
We included adults admitted for major trauma between 2006 and 2016 in a Canadian provincial trauma system. Analyses were stratified for orthopaedic (n = 16 887), neurological (n = 12 888) and torso injuries (n = 9816). Surgical intensity was quantified with the number of surgical procedures <72 hours. Inter‐hospital variation was assessed with the intra‐class correlation coefficient (ICC). We assessed the correlation between the risk‐adjusted mean number of surgical procedures and risk‐adjusted incidence of mortality and complications using Pearson correlation coefficients (r).
Results
Moderate inter‐hospital variation was observed for orthopaedic surgery (ICC = 14.0%) whereas variation was low for torso surgery (ICC = 2.7%) and neurosurgery (ICC = 0.8%). Surgical intensity was negatively correlated with hospital mortality for torso injury (r = −.32, P = .02) and neurotrauma (r = −.65, P = .08). A strong positive correlation was observed with hospital complications for orthopaedic injuries (r = .36, P = .006) whereas the opposite was observed for neurotrauma (r = −.71, P = .05).
Conclusions
Results should be interpreted with caution as they may be a result of residual confounding. However, they may suggest that there are opportunities for quality improvement in surgical care for injury admissions, particularly for orthopaedic injuries. Moving forward, we should aim to prospectively evaluate adherence to guidelines on non‐operative management and their impact on mortality and morbidity.</description><identifier>ISSN: 1368-5031</identifier><identifier>EISSN: 1742-1241</identifier><identifier>DOI: 10.1111/ijcp.13613</identifier><identifier>PMID: 32683730</identifier><language>eng</language><publisher>England: Hindawi Limited</publisher><subject>Adult ; Canada ; Cohort analysis ; Cohort Studies ; Hospitals ; Humans ; Injuries ; Morbidity ; Mortality ; Neurosurgery ; Orthopedics ; Quality control ; Retrospective Studies ; Surgery ; Trauma ; Trauma Centers ; Variation</subject><ispartof>International journal of clinical practice (Esher), 2020-11, Vol.74 (11), p.e13613-n/a</ispartof><rights>2020 John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3933-dc70e425e8e2b9b4ebca09aa817c5512e831b1790f117b4b83ecad644cfed2553</citedby><cites>FETCH-LOGICAL-c3933-dc70e425e8e2b9b4ebca09aa817c5512e831b1790f117b4b83ecad644cfed2553</cites><orcidid>0000-0002-6143-8888</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fijcp.13613$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fijcp.13613$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32683730$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patton, Marie‐Pier</creatorcontrib><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Farhat, Imen</creatorcontrib><creatorcontrib>Tardif, Pier‐Alexandre</creatorcontrib><creatorcontrib>Gonthier, Catherine</creatorcontrib><creatorcontrib>Belcaid, Amina</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Turgeon, Alexis</creatorcontrib><creatorcontrib>Clément, Julien</creatorcontrib><title>Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study</title><title>International journal of clinical practice (Esher)</title><addtitle>Int J Clin Pract</addtitle><description>Background
Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter‐hospital variation in surgical intensity for injury admissions and evaluate the correlation between hospital surgical intensity and mortality/complications.
Methods
We included adults admitted for major trauma between 2006 and 2016 in a Canadian provincial trauma system. Analyses were stratified for orthopaedic (n = 16 887), neurological (n = 12 888) and torso injuries (n = 9816). Surgical intensity was quantified with the number of surgical procedures <72 hours. Inter‐hospital variation was assessed with the intra‐class correlation coefficient (ICC). We assessed the correlation between the risk‐adjusted mean number of surgical procedures and risk‐adjusted incidence of mortality and complications using Pearson correlation coefficients (r).
Results
Moderate inter‐hospital variation was observed for orthopaedic surgery (ICC = 14.0%) whereas variation was low for torso surgery (ICC = 2.7%) and neurosurgery (ICC = 0.8%). Surgical intensity was negatively correlated with hospital mortality for torso injury (r = −.32, P = .02) and neurotrauma (r = −.65, P = .08). A strong positive correlation was observed with hospital complications for orthopaedic injuries (r = .36, P = .006) whereas the opposite was observed for neurotrauma (r = −.71, P = .05).
Conclusions
Results should be interpreted with caution as they may be a result of residual confounding. However, they may suggest that there are opportunities for quality improvement in surgical care for injury admissions, particularly for orthopaedic injuries. Moving forward, we should aim to prospectively evaluate adherence to guidelines on non‐operative management and their impact on mortality and morbidity.</description><subject>Adult</subject><subject>Canada</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Injuries</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Neurosurgery</subject><subject>Orthopedics</subject><subject>Quality control</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Trauma</subject><subject>Trauma Centers</subject><subject>Variation</subject><issn>1368-5031</issn><issn>1742-1241</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90Mtq3DAUBmBRWjqTyyYPUATdhIBTHcuy7OzCkMuUQLtI1kaWjxMNtuVKcot3eYQ-Y5-kSpx0kUW1kRAfP-f8hBwBO4V4vpidHk-B58DfkTXILE0gzeB9fPO8SATjsCJ73u8YS4Uo2Eey4mlecMnZmtTbIaD78_j7wfrRBNXRn8oZFYwdqBmon9y90fHXRDZ4E2baWkeDU1OvqGp6432k_oye037qgtE4BIdU2wfrAvVhauYD8qFVncfDl3uf3F1e3G6uk5tvV9vN-U2iecl50mjJMEsFFpjWZZ1hrRUrlSpAaiEgxYJDDbJkLYCss7rgqFWTZ5lusYmL8X1yvOSOzv6Y0IcqTqex69SAdvJVGsNFCbLII_38hu7s5IY4XVQCRCYZyKhOFqWd9d5hW43O9MrNFbDqqfnqqfnqufmIP71ETnWPzT_6WnUEsIBfpsP5P1HV9uvm-xL6F7nckB8</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Patton, Marie‐Pier</creator><creator>Moore, Lynne</creator><creator>Farhat, Imen</creator><creator>Tardif, Pier‐Alexandre</creator><creator>Gonthier, Catherine</creator><creator>Belcaid, Amina</creator><creator>Lauzier, François</creator><creator>Turgeon, Alexis</creator><creator>Clément, Julien</creator><general>Hindawi Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TK</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6143-8888</orcidid></search><sort><creationdate>202011</creationdate><title>Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study</title><author>Patton, Marie‐Pier ; Moore, Lynne ; Farhat, Imen ; Tardif, Pier‐Alexandre ; Gonthier, Catherine ; Belcaid, Amina ; Lauzier, François ; Turgeon, Alexis ; Clément, Julien</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3933-dc70e425e8e2b9b4ebca09aa817c5512e831b1790f117b4b83ecad644cfed2553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Canada</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Injuries</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Neurosurgery</topic><topic>Orthopedics</topic><topic>Quality control</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Trauma</topic><topic>Trauma Centers</topic><topic>Variation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patton, Marie‐Pier</creatorcontrib><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Farhat, Imen</creatorcontrib><creatorcontrib>Tardif, Pier‐Alexandre</creatorcontrib><creatorcontrib>Gonthier, Catherine</creatorcontrib><creatorcontrib>Belcaid, Amina</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Turgeon, Alexis</creatorcontrib><creatorcontrib>Clément, Julien</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of clinical practice (Esher)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patton, Marie‐Pier</au><au>Moore, Lynne</au><au>Farhat, Imen</au><au>Tardif, Pier‐Alexandre</au><au>Gonthier, Catherine</au><au>Belcaid, Amina</au><au>Lauzier, François</au><au>Turgeon, Alexis</au><au>Clément, Julien</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study</atitle><jtitle>International journal of clinical practice (Esher)</jtitle><addtitle>Int J Clin Pract</addtitle><date>2020-11</date><risdate>2020</risdate><volume>74</volume><issue>11</issue><spage>e13613</spage><epage>n/a</epage><pages>e13613-n/a</pages><issn>1368-5031</issn><eissn>1742-1241</eissn><abstract>Background
Guidelines for injury care are increasingly moving away from surgical management towards less invasive procedures but there is a knowledge gap on how these recommendations are influencing practice. We aimed to assess inter‐hospital variation in surgical intensity for injury admissions and evaluate the correlation between hospital surgical intensity and mortality/complications.
Methods
We included adults admitted for major trauma between 2006 and 2016 in a Canadian provincial trauma system. Analyses were stratified for orthopaedic (n = 16 887), neurological (n = 12 888) and torso injuries (n = 9816). Surgical intensity was quantified with the number of surgical procedures <72 hours. Inter‐hospital variation was assessed with the intra‐class correlation coefficient (ICC). We assessed the correlation between the risk‐adjusted mean number of surgical procedures and risk‐adjusted incidence of mortality and complications using Pearson correlation coefficients (r).
Results
Moderate inter‐hospital variation was observed for orthopaedic surgery (ICC = 14.0%) whereas variation was low for torso surgery (ICC = 2.7%) and neurosurgery (ICC = 0.8%). Surgical intensity was negatively correlated with hospital mortality for torso injury (r = −.32, P = .02) and neurotrauma (r = −.65, P = .08). A strong positive correlation was observed with hospital complications for orthopaedic injuries (r = .36, P = .006) whereas the opposite was observed for neurotrauma (r = −.71, P = .05).
Conclusions
Results should be interpreted with caution as they may be a result of residual confounding. However, they may suggest that there are opportunities for quality improvement in surgical care for injury admissions, particularly for orthopaedic injuries. Moving forward, we should aim to prospectively evaluate adherence to guidelines on non‐operative management and their impact on mortality and morbidity.</abstract><cop>England</cop><pub>Hindawi Limited</pub><pmid>32683730</pmid><doi>10.1111/ijcp.13613</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-6143-8888</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1368-5031 |
| ispartof | International journal of clinical practice (Esher), 2020-11, Vol.74 (11), p.e13613-n/a |
| issn | 1368-5031 1742-1241 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2425591786 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Canada Cohort analysis Cohort Studies Hospitals Humans Injuries Morbidity Mortality Neurosurgery Orthopedics Quality control Retrospective Studies Surgery Trauma Trauma Centers Variation |
| title | Inter‐hospital variation in surgical intensity for trauma admissions: A multicentre cohort study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T10%3A40%3A04IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Inter%E2%80%90hospital%20variation%20in%20surgical%20intensity%20for%20trauma%20admissions:%20A%20multicentre%20cohort%20study&rft.jtitle=International%20journal%20of%20clinical%20practice%20(Esher)&rft.au=Patton,%20Marie%E2%80%90Pier&rft.date=2020-11&rft.volume=74&rft.issue=11&rft.spage=e13613&rft.epage=n/a&rft.pages=e13613-n/a&rft.issn=1368-5031&rft.eissn=1742-1241&rft_id=info:doi/10.1111/ijcp.13613&rft_dat=%3Cproquest_cross%3E2425591786%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2451547017&rft_id=info:pmid/32683730&rfr_iscdi=true |