Increased hospital treatment volume of splenic injury predicts higher rates of successful non-operative management and reduces hospital length of stay: a Swiss Trauma Registry analysis

Lavanchy, Joël L.; Delafontaine, Luciane; Haltmeier, Tobias; Bednarski, Piotr; Schnüriger, Beat (2021). Increased hospital treatment volume of splenic injury predicts higher rates of successful non-operative management and reduces hospital length of stay: a Swiss Trauma Registry analysis. European journal of trauma and emergency surgery Springer-Medizin-Verlag 10.1007/s00068-020-01582-z

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Purpose: First time analysis of the epidemiology, management and outcomes of patients with splenic injuries in Switzerland. This study aims to assess the effect of hospital treatment volume on successful non-operative management (NOM) in splenic injuries.

Methods: A multicentric registry-based study including all patients with splenic injuries entered into the Swiss Trauma Registry from 2015 to 2018 was conducted. Patients were stratified according to the hospitals treatment volume of splenic injuries. Primary outcome was the rate of successful NOM.

Results: During the 4-year study period, 652 patients with splenic injury were included in the study. Median age of the study population was 42 (IQR 27-59) years, and median ISS was 26 (20-34). The overall rate of successful NOM was 86.5%. Median HLOS was 13 (8-21) days. In-hospital mortality was 7.2% (n = 47). The mean number of patients with splenic injuries per center and year was 14. Five out of 12 Level I trauma centers treating more patients than the mean (≥ 15/year) were defined as high-volume centers. Multivariable analysis adjusting for differences in baseline and injury characteristics revealed treatment in a high-volume center as an independent predictor for successful NOM (OR 2.15, 95% CI 1.28-3.60, p = 0.004) and shorter HLOS (RC - 2.39, 95% CI - 4.91/- 0.48, p = 0.017), however, not for reduced in-hospital mortality (OR 0.92, 95% CI 0.39-2.18, p = 0.845).

Conclusion: Higher hospital treatment volume was associated with a higher rate of NOM and shorter HLOS, but not lower mortality. These results constitute the basis for further quality improvement in the care of splenic injury patients within the trauma system in Switzerland.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Lavanchy, Joël Lukas; Delafontaine, Luciane; Haltmeier, Tobias; Bednarski, Piotr and Schnüriger, Beat

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1863-9933

Publisher:

Springer-Medizin-Verlag

Language:

English

Submitter:

Joël Lukas Lavanchy

Date Deposited:

19 Apr 2021 11:31

Last Modified:

19 Apr 2021 11:31

Publisher DOI:

10.1007/s00068-020-01582-z

PubMed ID:

33484278

BORIS DOI:

10.7892/boris.153603

URI:

https://boris.unibe.ch/id/eprint/153603

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