Hospital factors associated with splenectomy for splenic injury: A national perspective

Rob R. Todd, Melanie Arthur, Craig Newgard, Jerris R. Hedges, Richard Mullins

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. Methods. Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. Results. Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. Conclusion. The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.

Original languageEnglish (US)
Pages (from-to)1065-1071
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number5
DOIs
StatePublished - Nov 2004

Fingerprint

Splenectomy
Urban Hospitals
Wounds and Injuries
Teaching Hospitals
Rural Hospitals
Laparotomy
Inpatients
Health Care Costs
International Classification of Diseases
Teaching

Keywords

  • Hospital factors
  • Laparotomy
  • Splenectomy
  • Splenic injury
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Hospital factors associated with splenectomy for splenic injury : A national perspective. / Todd, Rob R.; Arthur, Melanie; Newgard, Craig; Hedges, Jerris R.; Mullins, Richard.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 5, 11.2004, p. 1065-1071.

Research output: Contribution to journalArticle

@article{f2768e676b524f2fa8aac3af0b50768d,
title = "Hospital factors associated with splenectomy for splenic injury: A national perspective",
abstract = "Background: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. Methods. Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. Results. Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28{\%} underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46{\%} had a laparotomy and 35{\%} underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36{\%} had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. Conclusion. The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.",
keywords = "Hospital factors, Laparotomy, Splenectomy, Splenic injury, Trauma",
author = "Todd, {Rob R.} and Melanie Arthur and Craig Newgard and Hedges, {Jerris R.} and Richard Mullins",
year = "2004",
month = "11",
doi = "10.1097/01.TA.0000103988.66443.0E",
language = "English (US)",
volume = "57",
pages = "1065--1071",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hospital factors associated with splenectomy for splenic injury

T2 - A national perspective

AU - Todd, Rob R.

AU - Arthur, Melanie

AU - Newgard, Craig

AU - Hedges, Jerris R.

AU - Mullins, Richard

PY - 2004/11

Y1 - 2004/11

N2 - Background: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. Methods. Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. Results. Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. Conclusion. The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.

AB - Background: The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ. Methods. Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days. Results. Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals. Conclusion. The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.

KW - Hospital factors

KW - Laparotomy

KW - Splenectomy

KW - Splenic injury

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=9644291402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=9644291402&partnerID=8YFLogxK

U2 - 10.1097/01.TA.0000103988.66443.0E

DO - 10.1097/01.TA.0000103988.66443.0E

M3 - Article

C2 - 15580034

AN - SCOPUS:9644291402

VL - 57

SP - 1065

EP - 1071

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -