Statewide variation in the treatment of patients hospitalized with spleen injury

Richard S. Mangus, N. Clay Mann, William Worrall, Richard Mullins

    Research output: Contribution to journalArticle

    12 Citations (Scopus)

    Abstract

    Hypothesis: Surgeons' treatment decisions for patients with spleen injuries in Washington state from January 1, 1990, through December 31, 1994, were different in rural compared with urban communities. Design and Settings: Retrospective cohort analyses using the Death and Illness History Database for the state of Washington, which provides a cross-linked record of an individual's sequential hospitalizations. Counties were defined as metropolitan, urban, or rural on the basis of population density. Patients: A total of 1905 patients (1927 hospitalizations) with an International Classification of Diseases, Ninth Revision, Clinical Modification, discharge diagnosis code of 865. Main Outcome Measures: Physician management decisions (perform a celiotomy or repair the spleen) were stratified by geographic region. Results: Throughout the state, there was substantial variability in the treatment of spleen-injured patients. Factors associated with higher odds of splenectomy included older age, overall severity of injury, treatment in rural hospitals, and treatment in the earlier years of study. While the frequency of splenic salvage increased over time, hospital length of stay, rehospitalization, and 30-day mortality did not increase. Conclusions: Injury to the spleen is a common problem for which management decisions vary by geographic region, indicating that a single management protocol does not universally apply. To evaluate appropriateness of care by process measures, such as splenic injury management, will require that decision makers grant some latitude in management variability based on factors such as practice setting.

    Original languageEnglish (US)
    Pages (from-to)1378-1384
    Number of pages7
    JournalArchives of Surgery
    Volume134
    Issue number12
    StatePublished - 1999

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    Spleen
    Wounds and Injuries
    Length of Stay
    Hospitalization
    Rural Hospitals
    Process Assessment (Health Care)
    International Classification of Diseases
    Splenectomy
    Therapeutics
    Population Density
    Cohort Studies
    History
    Outcome Assessment (Health Care)
    Databases
    Physicians
    Mortality

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Statewide variation in the treatment of patients hospitalized with spleen injury. / Mangus, Richard S.; Mann, N. Clay; Worrall, William; Mullins, Richard.

    In: Archives of Surgery, Vol. 134, No. 12, 1999, p. 1378-1384.

    Research output: Contribution to journalArticle

    Mangus, RS, Mann, NC, Worrall, W & Mullins, R 1999, 'Statewide variation in the treatment of patients hospitalized with spleen injury', Archives of Surgery, vol. 134, no. 12, pp. 1378-1384.
    Mangus, Richard S. ; Mann, N. Clay ; Worrall, William ; Mullins, Richard. / Statewide variation in the treatment of patients hospitalized with spleen injury. In: Archives of Surgery. 1999 ; Vol. 134, No. 12. pp. 1378-1384.
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    abstract = "Hypothesis: Surgeons' treatment decisions for patients with spleen injuries in Washington state from January 1, 1990, through December 31, 1994, were different in rural compared with urban communities. Design and Settings: Retrospective cohort analyses using the Death and Illness History Database for the state of Washington, which provides a cross-linked record of an individual's sequential hospitalizations. Counties were defined as metropolitan, urban, or rural on the basis of population density. Patients: A total of 1905 patients (1927 hospitalizations) with an International Classification of Diseases, Ninth Revision, Clinical Modification, discharge diagnosis code of 865. Main Outcome Measures: Physician management decisions (perform a celiotomy or repair the spleen) were stratified by geographic region. Results: Throughout the state, there was substantial variability in the treatment of spleen-injured patients. Factors associated with higher odds of splenectomy included older age, overall severity of injury, treatment in rural hospitals, and treatment in the earlier years of study. While the frequency of splenic salvage increased over time, hospital length of stay, rehospitalization, and 30-day mortality did not increase. Conclusions: Injury to the spleen is a common problem for which management decisions vary by geographic region, indicating that a single management protocol does not universally apply. To evaluate appropriateness of care by process measures, such as splenic injury management, will require that decision makers grant some latitude in management variability based on factors such as practice setting.",
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