Emergency general surgery volume and its impact on outcomes in military treatment facilities

Authors

Muhammad Ali Chaudhary, Harvard Medical School, Boston
Peter A. Learn, Uniformed Services University of the Health Sciences, Bethesda
Daniel J. Sturgeon, Harvard Medical School, Boston
Joaquim M. Havens, Harvard Medical School, Boston
Eric Goralnick, Harvard Medical School, Boston
Tracey Koehlmoos, Uniformed Services University of the Health Sciences, Bethesda
Adil H. Haider, Brigham and Women's Hospital, Harvard Medical School, BostonFollow
Andrew J. Schoenfeld, Harvard Medical School, Boston

Document Type

Article

Department

General Surgery

Abstract

Background: Low hospital volume for emergency general surgery (EGS) procedures is associated with worse patient outcomes within the civilian health care system. The military maintains treatment facilities (MTFs) in remote locations to provide access to service members and their families. We sought to determine if patients treated at low-volume MTFs for EGS conditions experience worse outcomes compared with high-volume centers.
Materials and methods: We analyzed TRICARE data from 2006 to 2014. Patients were identified using an established coding algorithm for EGS admission. MTFs were divided into quartiles based on annual EGS volume. Outcomes included 30-d mortality, complications, and readmissions. Logistic regression models adjusting for clinical and sociodemographic differences in case-mix including EGS condition, surgical intervention, and comorbidities were used to determine the influence of hospital volume on outcomes.
Results: We identified 106,915 patients treated for an EGS condition at 79 MTFs. The overall mortality rate was 0.21%, with complications occurring in 8.55% and readmissions in 4.45%. After risk adjustment, lowest-volume MTFs did not demonstrate significantly higher odds of mortality (OR: 2.02, CI: 0.45-9.06) or readmissions (OR: 0.77, CI: 0.54-1.11) compared with the highest-volume centers. Lowest-volume facilities exhibited a lower likelihood of complications (OR: 0.76, CI: 0.59-0.98).
Conclusions: EGS patients treated at low-volume MTFs did not experience worse clinical outcomes when compared with high-volume centers. Remote MTFs appear to provide care for EGS conditions comparable with that of high-volume facilities. Our findings speak against the need to reduce services at small, critical access facilities within the military health care system.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Journal of Surgical Research

Recommended Citation

Chaudhary, M. A., Learn, P. A., Sturgeon, D. J., Havens, J. M., Goralnick, E., Koehlmoos, T., Haider, A. H., Schoenfeld, A. J. (2020). Emergency general surgery volume and its impact on outcomes in military treatment facilities. Journal of Surgical Research, 247, 287-293.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/185