Abstract
Background
Benchmarking of mortality outcomes across the country has revealed major differences
in survival based on the trauma center at which a patient receives care. The role
of the individual surgeon in determining trauma outcomes is unknown. Most believe
that differences in outcomes are primarily driven by system- and process-based variations.
Our objective was to determine if variation in individual surgeon outcomes could help
explain difference in survival after trauma.
Methods
Analysis of trauma patients in the Florida State Inpatient Database from 2010 to 2014.
The presence of unique physician identifiers, in addition to hospital identifiers,
rendered this data set ideal for performance of multilevel analysis. The amount of
the variation attributable to surgeon-level variation was calculated using multilevel
random-effects models controlling for patient clinical factors (such as injury severity
and comorbidities/age) and hospital-level factors, such as case mix and bed size.
Results
There were 31 hospitals, 175 surgeons, and 65,706 admissions. The overall mortality
rate was 5.6%. The average mortality rate across surgeons ranged from 0% to 17.4%
(mean 0.4%, standard deviation 1.85). At the individual surgeon level, when controlling
for clinical and hospital-level factors, 9% of this variation was attributable solely
to the surgeon.
Conclusions
At the state level, we found that differences in outcomes among trauma centers are
impacted by individual surgeon-level variation. Implementation of protocolized, system-based
trauma care is useful for improving the overall quality of care for injured patients
but does not entirely negate surgeon-specific variations in management.
Keywords
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Article info
Publication history
Published online: April 16, 2018
Accepted:
February 23,
2018
Received in revised form:
January 29,
2018
Received:
December 19,
2017
Footnotes
Portions of this research were presented at the Society for Asian Academic Surgeons 2017 Plenary Session in Birmingham, AL.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
