Rare and Tricky: The Relationship Between Hospital Trauma Volume and Delay in Surgical Intervention in Blunt Intestinal Injury.

Abstract

This study aimed to evaluate the impact of hospital blunt intestinal injury (BInI) trauma volume on time to surgery in patients with BInI. The diagnosis of BInI is challenging, even for trauma experts, leading to frequent delays in necessary surgical intervention. The 2017-2020 ACS-TQIP database was used to identify patients ≥18 years with full-thickness ileal, jejunal, or colonic perforation secondary to blunt trauma. Hospitals were stratified by the annual volume of BInI. Multivariable logistic regression adjusting for demographics, comorbidities, and injury characteristics/severity was used to study the impact of hospital trauma volume on delayed surgery (>24 hours) and outcomes (e.g. mortality, sepsis). Sensitivity analyses were performed classifying hospitals by their volume of (1) blunt trauma and (2) all trauma admissions. Out of a total of 4,005,762 trauma patients, 3,954 were included: 1,397 (35.3%) in low BInI volume, 1,373 (34.7%) in medium BInI volume, and 1,184 (30%) in high BInI volume hospitals. The mean time to surgery was 18±46 hours in low-volume compared to 15±45 hours in high-volume hospitals (P<0.001). On multivariable analysis, high BInI volume was independently associated with early surgery (aOR for delayed surgery 0.68, 95% CI 0.53-0.88) and a 42% lower risk of post-injury sepsis (aOR 0.58, 95% CI 0.37-0.91) compared to low BInI volume. High blunt trauma and all trauma hospital volumes were similarly associated with early surgery (aOR 0.65, 95% CI 0.51-0.84; aOR 0.66, 95% CI 0.51-0.85, respectively). High trauma hospital volume is independently associated with prompt surgical intervention and improved outcomes in patients with BInI. These findings highlight the importance of clinical trauma experience and available resources for trauma care in early diagnosis and management of the rare and tricky intestinal injuries.