TY  - JOUR
PY  - 2020//
TI  - Impact of trauma center volume on major vascular injury: an analysis of the National Trauma Data Bank (NTDB)
JO  - American journal of surgery
A1  - Taghavi, Sharven
A1  - Jones, Glenn
A1  - Duchesne, Juan
A1  - McGrew, Patrick
A1  - Guidry, Chrissy
A1  - Schroll, Rebecca
A1  - Harris, Charles
A1  - Nkansah, Reginald
A1  - Jacome, Tomas
A1  - Tatum, Danielle
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: The association of procedure volume and improved outcomes has been established with infrequently performed elective operations. However, effect of trauma center volume on outcomes in emergency surgery has not been defined. We hypothesized that high volume centers (HVC) would provide better outcomes for operative major vascular injuries (MVI) than low volume centers (LVC). <br><br>METHODS: The NTDB was queried from 2010 to 2014. Patients with MVI were identified and HVC were compared to LVC. HVC were defined as >480 patients per year with ISS≥15. <br><br>RESULTS: There were 37,125 patients with MVI, with 16,461 (44.3%) managed operatively. Of these, 15,965 (97%) underwent surgery at HVC and 496 (3%) at LVC. There was no difference in shunt utilization, however, HVC were more likely to utilize endovascular repair (31.0% vs. 21.9%, p < 0.001). Rates of death, amputation, and compartment syndrome were similar. HVC were more likely to develop pneumonia or sepsis. On logistic regression, HVC was not associated with survival (OR: 0.90, 95%CI: 0.60-1.34, p = 0.60). Variables associated with mortality for HVC and LVC included thoracic arterial injury (OR: 1.57, 95%CI: 1.27-1.94, p < 0.001), penetrating mechanism (OR:1.84, 95%CI: 1.57-2.15, p < 0.001), and open repair (OR: 1.95, 95%CI: 1.69-2.26, p < 0.001). Lower ISS (OR: 0.29, 95%CI: 0.24-0.34, p < 0.001) and higher presenting blood pressure (OR: 0.99, 95%CI: 0.99-1.00, p < 0.001) were associated with survival. <br><br>CONCLUSIONS: Although LVC may have less proficiency with endovascular techniques, trauma center volume does not influence survival in emergency surgery for MVI.<br><br>Copyright © 2020 Elsevier Inc. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0002-9610
UR  - http://dx.doi.org/10.1016/j.amjsurg.2020.01.026
ID  - ref1
ER  -