Abstract
Background
There are an estimated 100,000 cases of abdominal injury (ABI) in the USA, annually resulting in over $12 billion in direct medical cost and $18 billion in lost productivity. This study assesses the timeliness, safety, and efficacy of the surgical management of abdominal injuries (ABIs), hollow viscus injuries (HVIs), and colonic injuries (CIs) for patients residing in New York State (NYS).
Methods
Using data from NYS’s Statewide Planning and Research Cooperative System (SPARCS), we identified all trauma patients with ABI admitted between 2006 and 2015. We subdivided ABI into HVI and CI using diagnosis and procedure codes and examined processes of care and outcomes adjusting for patient characteristics, injury severity score, structural, and process indicators.
Results
We identified 31,043 hospitalized patients with ABI, 71% were incurred from blunt forces. Most patients with ABI (72%) were treated at a Level I/II trauma center (TC) and 7% patients were transferred to Level I/II TC. Failure to be treated at Level I/II TC was associated with 16% increased hazard of death. HVI was diagnosed in 23% of ABI patients (n = 7294); 18% experienced delayed hollow viscus repair (dHVR); dHVR was associated with a 76% increased hazard of death. CI was diagnosed in 9% of ABI patients (n = 2921) and 18% experienced dHVR. Seventy-five percent of CI were repaired primarily (n = 1354). Less than 37% of stomas were reversed by 4 years of index trauma.
Conclusion
Most abdominal trauma in NYS was caused by motor vehicle accidents, falls, and assault. dHVR and not being treated at Level I/II TC were associated with worse outcomes. More research is needed to reduce under-triage and delays in the operative treatment of blunt abdominal trauma.
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Funding
This manuscript was funded by the New York State Empire Clinical Research Investigator Program (ECRIP) at Buffalo General Hospital and the Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
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Dr. Schwaitzberg is a paid consultant for Nu View Surgical, Acuity Bio, Activ Surgical, Human Extensions, Levitra Magnetics, Amsel Surgical, and Arch Therapeutics (not related to the study). Dr. Hoffman proctored for Standard Bariatrics, Inc. and received compensation for food and travel from Intuitive Surgical, Inc. for training purposes. Drs. Simmonds, Myneni, Gray, Jordan, and Noyes and Ms. Towle-Miller do not have any conflict of interest to disclose.
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Simmonds, I., Towle-Miller, L.M., Myneni, A.A. et al. Is New York State good at managing hollow viscus injury?. Surg Endosc 36, 6789–6800 (2022). https://doi.org/10.1007/s00464-021-08964-3
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DOI: https://doi.org/10.1007/s00464-021-08964-3