Hospital Trauma Volume and the Risk of Post-Injury Sepsis in Blunt Intestinal Injury: A Nationwide Analysis

Authors:
Yasmin Arda, Ioannis Karikis, John Hwabejire, Michael DeWane, Charudutt Paranjape, Joshua Ng-Kamstra, Lydia Maurer, Matthew Bartek, Jonathan Parks, Ali Salim, George Velmahos, Haytham Kaafarani

Body of Abstract:
Background: Blunt intestinal injury (BInI) is rare and often difficult to diagnose, resulting in delay in intervention and worse outcomes. This study aimed to evaluate whether hospital BInI volume influences the risk of post-injury sepsis in patients with BInI.

Methods: The 2017-2020 ACS-TQIP database was used to identify patients ≥18 years of age with full-thickness ileal, jejunal, or colonic perforation secondary to blunt trauma. Hospitals were stratified into tertiles by annual BInI volume. Multivariable logistic regression adjusting for demographics, comorbidities, and injury characteristics/severity was used to assess the impact of hospital volume on the risk of post-injury sepsis. To examine the potential role of delayed recognition, sensitivity analyses were conducted by stratifying patients undergoing early versus delayed (>24 hours) surgical intervention.

Results: 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 age was 41±18 years, 37% were females, the mean injury severity score was 19±10, and the most common injury was jejunal or ileal perforation (66%). On multivariable analyses, high BInI volume was independently associated with a 45% lower risk of post-injury sepsis (aOR 0.55, 95% CI 0.36-0.86) compared to low BInI volume. This association was not statistically observed in sensitivity analyses stratified by timing of surgery.

Conclusions: High trauma hospital volume of BInI is independently associated with decreased risk of post-injury sepsis. The attenuation of this effect after stratifying by operative timing may partially be related to earlier surgical intervention at high volume hospitals.