More operations, more deaths? relationship between operative intervention rates and risk-adjusted mortality at trauma centers

Shahid Shafi, Jennifer Parks, Chul Ahn, Larry M. Gentilello, Avery B. Nathens

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Introduction: The Trauma Quality Improvement Project has demonstrated significant variations in risk-adjusted mortality rates across the designated trauma centers. It is not known whether the outcome differences are related to provider-level clinical decision making. We hypothesized that centers with good outcomes undertake critical operative interventions aggressively, thereby avoiding complications and deaths. Methods: The previously validated Trauma Quality Improvement Project risk-adjustment algorithm was used to measure observed-to-expected mortality rates (O/E with 90% confidence intervals [CI]) for 152 Level I and II trauma centers participating in the National Trauma Data Bank (version 7.0). Adult patients (≥16 years) with at least one severe injury (Abbreviated Injury Scale score ≥3) were included (N = 135,654). Operative intervention rates for solid organ injuries (spleen, liver, and kidney) were compared between the centers classified as high mortality (O/E with CI > 1, n = 35 centers) versus low mortality (O/E with CI < 1, n = 37 centers) using nonparametric tests. Results: Low- and high-mortality trauma centers were similar in designation level, hospital and intensive care unit beds, teaching status, and number of trauma, orthopedic, and neurosurgeons. Despite a similar incidence and severity of solid organ injuries, low-mortality centers were less likely to undertake operative interventions. Conclusion: Trauma centers with higher risk-adjusted mortality rates are more likely to undertake operative interventions for solid organ injuries. Hence, there is a need to focus quality improvement efforts on medical decision-making and perioperative processes of care.

Original languageEnglish (US)
Pages (from-to)70-77
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number1
StatePublished - Jul 1 2010


  • Operative interventions
  • Risk-adjusted mortality
  • Trauma Quality Improvement Project

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'More operations, more deaths? relationship between operative intervention rates and risk-adjusted mortality at trauma centers'. Together they form a unique fingerprint.

Cite this