The following is a summary of “Outcomes by time-to-OR for penetrating abdominal trauma patients,” published in the May 2024 issue of Emergency Medicine by Grisel, et al.
Time-To-OR (time to operating room) is crucial in assessing trauma performance. However, its correlation with improved patient outcomes needs to be more consistent.
Utilizing data from the Trauma Quality Improvement Program (TQIP), hospitals were categorized into slow, average, and fast facilities based on the 75th percentile time-to-OR. A generalized estimating equation (GEE) model was employed to determine the odds of mortality among patients with penetrating abdominal trauma, firearm injuries only, and those with major complications based on facility speed. Patient-level odds of mortality were also estimated.
At slow facilities, the odds of mortality for patients were 1.095 (95% CI: 0.746, 1.608; P = 0.64) compared to average facilities, while for fast facilities, the odds were 0.941 (95% CI: 0.780, 1.133; P = 0.52). At the patient level, each additional minute of time-to-OR was associated with a 1.5% decrease in odds of in-hospital mortality (OR 0.985; 95% CI: 0.981, 0.989; P < 0.001). Facility speed did not affect the odds of in-hospital mortality for firearm-only patients (P = 0.61). However, at the patient level, each additional minute of time-to-OR was associated with a 1.8% decrease in odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; P < 0.001). Similarly, failure-to-rescue analysis revealed no difference in in-hospital mortality at the patient level (P = 0.62), with each additional minute of time-to-OR associated with a 0.4% decrease in odds of in-hospital mortality (OR 0.996; 95% CI: 0.993, 0.999; P = 0.004).
Despite its widespread use, time-to-OR may not be a reliable indicator of trauma performance in terms of mortality or complication rates at either the facility or patient level. Alternative performance metrics should be developed to reflect patient outcomes in trauma care better.
Reference: sciencedirect.com/science/article/abs/pii/S0735675724000780
