Acute care surgery: Defining mortality in emergency general surgery in the state of Maryland

Background Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). Study Design A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR-SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. Results There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR-SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR-SOI. For moderate APR-SOI, mortality was significantly lower for TCs compared with NTCs (p < 0.001). Among TCs, the effect was strongest for Level I TC (odds ratio = 0.34). For extreme APR-SOI, mortality was higher at TCs vs NTCs (p < 0.001). Conclusions Emergency general surgery patients treated at TCs had lower mortality for moderate APR-SOI, but increased mortality for extreme APR-SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding.