Abstract
Background
The long-term consequences of in-hospital complications remain largely unknown. We
sought to study the effect of complications on the long-term functional outcome of
trauma patients.
Methods
Patients with an Injury Severity Score ≥ 9 admitted to 3, level I trauma centers between
2015 and 2017 were contacted 6 to 12 months postinjury and administered a validated
trauma quality-of-life survey, assessing for the presence of any functional limitation.
Functional limitation was defined as the inability to perform independently one or
more activities of daily living (eg, driving, walking on flat surfaces/upstairs, dressing).
Medical records and the trauma registry were reviewed systematically for all patient
and injury variables. The occurrence of predefined in-hospital complications (eg,
pneumonia, surgical site infection) was recorded. The impact of in-hospital complications
on functional limitation was assessed using multivariate logistic regression models.
Results
Of 1,709 patients, 1,022 completed the study. The mean age was 58 y, 56% were male,
94% had blunt trauma, and the mean Injury Severity Score was 15. A total of 168 patients
(16.4%) had a minimum of 1 in-hospital complication and reported significantly more
functional limitations in most activities of daily living at 6 to 12 months, compared
with those without complications. In multivariable analyses adjusting for confounders,
the occurrence of complications was associated with a greater likelihood of functional
limitation 6 to 12 months postinjury (odds ratio = 1.82, 95% confidence interval 1.22–2.69,
P = .003).
Conclusion
Trauma patients with in-hospital complications have a worse long-term functional outcome.
In addition to prevention of primary complications, more rehabilitation resources
should be made available to trauma patients who survive complications.
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Article info
Publication history
Published online: June 29, 2019
Accepted:
April 24,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
