Background: The American College of Surgeons (ACS) verifies trauma centers (TCs) using annual trauma volume (ATV) without incorporating procedural volume (PV). We compared outcomes at level I TCs based on ATV versus PV. Study Design: We performed a five-year (2017-2021) retrospective analysis of the ACS-TQIP including trauma patients treated at ACS level I TCs. Centers were grouped into tertiles of low (LV), medium (MV), and high volume (HV) by ATV and PV. PV was defined as annual emergent laparotomies, thoracotomies, craniectomies/craniotomies, angioembolizations, and vascular repairs. Outcomes were in-hospital mortality and major complications. Multivariable regression assessed independent associations between volume metrics and outcomes. Results: 2,218,425 patients at 182 level I TCs (LV: 91, MV: 54, HV: 37), with 34.6% (n= 766,555) undergoing procedural intervention were identified. The mean (SD) age was 48(23) and 63% were male. When stratified by PV, HV TCs had significantly lower rates of mortality (LV: 5.4%, MV: 4.4%, HV: 3.7%, p<0.001) and major complications (LV: 8.1%, MV: 3.8%, HV: 3.1%, p<0.001). However, when stratified by ATV, HV TCs had higher mortality rates (LV: 3.9%, MV: 4.2%, HV: 4.5%, p<0.001), while MV TCs had the highest major complication rates (LV:4.7%, MV:5.3%, HV:4.8%, p<0.001). After adjusting for potential confounders, higher PV was independently associated with lower odds of mortality and major complications. Conclusions: PV, rather than ATV, is a superior predictor of improved outcomes. Integrating PV into the trauma center verification criteria may enhance the regionalization of trauma care based on injury-specific patient needs.
Joseph et al. (Tue,) studied this question.
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