Background
The National Surgical Quality Improvement Program (NSQIP) has reduced complications
for surgery patients in the Department of Veterans Affairs Healthcare System. The
American College of Surgeons Committee on Trauma maintains the National Trauma Data
Bank (NTDB) to track injured patient comorbidities, complications, and mortality.
We sought to apply the NSQIP methodology to collect comorbidity and outcome data for
trauma patients. Data were compared to the NTDB to determine the benefit and validity
of using the NSQIP methodology for trauma.
Study Design
Utilizing the NSQIP methodology, data were collected from August 1, 2004 to July 31,
2005 on all adult patients admitted to the trauma service at a level 1 trauma center.
NSQIP data were collected for general surgery patients during the same time period
from the same institution. Data were also extracted from v5.0 of the NTDB for patients
≥18 years old admitted to level 1 trauma centers. Comparisons between University of
Michigan (UM) NSQIP Trauma and UM NSQIP General Surgery patients and between UM NSQIP
Trauma and NTDB (2004) patients were performed using univariate and multivariate analysis.
Results
Before risk adjustment, there was a difference in mortality between the UM NSQIP Trauma
and NTDB (2004) groups with univariate analysis (8.4% vs 5.7%; odds ratio [OR], 0.7;
95% confidence interval [CI] 0.5-0.9; P = .01). This survival advantage reversed to favor the UM NSQIP Trauma patient group
when risk adjustment was performed (OR, 2.3; 95% CI, 1.6-3.4; P < .001). The UM NSQIP Trauma group had more complications than the UM NSQIP general
surgery patients. Despite having a lower risk-adjusted rate of mortality, the UM NSQIP
Trauma patients had significantly higher rates of complications (wound infection,
wound disruption, pneumonia, urinary tract infection, deep vein thrombosis, and sepsis)
than the NTDB (2004) patients in both univariate and multivariate analyses.
Conclusion
Complications occurred more frequently in trauma patients than general surgery patients.
The UM NSQIP Trauma patients had higher rates of complications than reported in the
NTDB. The NTDB data potentially underreport important comorbidity and outcome data.
Application of the NSQIP methodology to trauma may present an improved means of effectively
tracking and reducing adverse outcomes in a risk-adjusted manner.
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Article info
Publication history
Accepted:
July 3,
2007
Footnotes
M.R.H. was supported by a Central Surgical Association Foundation Enrichment Grant and an American Association for the Surgery of Trauma Research and Education Foundation Scholarship.
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
