Early operative management in trauma: A nationwide comparison of time to surgery and survival at trauma centers and non-trauma centers.

Abstract

Trauma is a leading cause of death and disability, both in Sweden and globally. Timely surgical intervention and level of care have been identified as important determinants of outcome, yet it is not known whether time to surgery differs between trauma centers and non-trauma centers in Sweden, or whether previously observed survival differences also apply to patients undergoing early operative management. This retrospective national cohort study included adult trauma patients (≥18 years) who underwent surgery within six hours of hospital arrival between 1 January 2019 and 21 March 2023. Data were obtained from Swedish national quality registries and administrative registers held by the National Board of Health and Welfare (Socialstyrelsen). The primary outcome was time from hospital arrival to initiation of surgery. Secondary outcomes were time to urgent surgery and 30-day mortality. Associations between trauma center status and outcomes were examined using regression models adjusted for demographic and injury-related factors. A total of 1129 adult trauma patients who underwent surgery within six hours of hospital arrival were included, the majority presenting with moderate to severe injuries; of whom 659 (58.4%) were treated at trauma centers and 470 (41.6%) at non-trauma centers. Patients treated at trauma centers had higher injury severity and greater physiological compromise. Trauma center care was associated with shorter time to surgery; the fully adjusted mean difference was 0.68 h compared with non-trauma centers. Crude 30-day mortality was higher at trauma centers, but after full adjustment for case-mix, trauma center care was associated with lower mortality. Among trauma patients undergoing early surgery, treatment at trauma centers was associated with shorter time to surgery and improved adjusted survival. Further research is needed to identify which patient groups may benefit most from direct transport to trauma centers.