Abstract
Purpose
The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma.
Methods
This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized.
Results
In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29–2.90]) and third (OR 1.67 [95% CI 1.08–2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile.
Conclusion
Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.
Similar content being viewed by others
References:
Madani A, Pecorelli N, Razek T, Spicer J, Ferri LE, Mulder DS. Civilian airway trauma: a single-institution experience. World J Surg. 2016;40(11):2658–66.
Sung EK, Nadgir RN, Sakai O. Computed tomographic imaging in head and neck trauma: what the radiologist needs to know. In: Paper presented at: Seminars in roentgenology, 2012;47(4):320–9
Bell RB, Verschueren DS, Dierks EJ. Management of laryngeal trauma. Oral Maxillofac Surg Clin N Am. 2008;20(3):415–30.
Moonsamy P, Sachdeva UM, Morse CR. Management of laryngotracheal trauma. Ann Cardiothorac Surg. 2018;7(2):210–6.
Thevasagayam M, Pracy P. Laryngeal trauma: a systematic approach to management. Trauma. 2005;7(2):87–94.
Lloyd R. Quality health care: a guide to develo** and using indicators. Jones & Bartlett Learning; 2017.
Donabedian A. Exploratings in quality assessment and monitoring definition of quality and approaches to its assessment. Ann Arbor. 1980;50:191.
Ryan AM, Doran T. The effect of improving processes of care on patient outcomes: evidence from the United Kingdom’s quality and outcomes framework. Med Care. 2012;50:191–9.
Webster P. Time to evaluate why high-volume hospitals have better surgical outcomes. In: Can Med Assoc; 2005; 173(2):140
Nathens AB, Jurkovich GJ, Maier RV, et al. Relationship between trauma center volume and outcomes. JAMA. 2001;285(9):1164–71.
Eskander A, Monteiro E, Irish J, et al. Adherence to guideline-recommended process measures for squamous cell carcinoma of the head and neck in Ontario: impact of surgeon and hospital volume. Head Neck. 2016;38(S1):E1987–92.
Srinivas V, Hailpern SM, Koss E, Monrad ES, Alderman MH. Effect of physician volume on the relationship between hospital volume and mortality during primary angioplasty. J Am Coll Cardiol. 2009;53(7):574–9.
Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777.
Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015;12(10):e1001885.
Shafi S, Nathens AB, Cryer HG, et al. The trauma quality improvement program of the American College of Surgeons Committee on Trauma. J Am Coll Surg. 2009;209(4):521-530.e521.
Hashmi ZG, Kaji AH, Nathens AB. Practical guide to surgical data sets: National Trauma Data Bank (NTDB). JAMA Surg. 2018;153(9):852–3.
Shafi S, Nathens AB, Parks J, Cryer HM, Fildes JJ, Gentilello LM. Trauma quality improvement using risk-adjusted outcomes. J Trauma Acute Care Surg. 2008;64(3):599–606.
Forner D, Noel CW, Guttman MP, et al. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. The Laryngoscope. 2020; 131(4):E1109–E1116
Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083–91.
Alali AS, Fowler RA, Mainprize TG, et al. Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program. J Neurotrauma. 2013;30(20):1737–46.
Chen AY, Halpern MT, Schrag NM, Stewart A, Leitch M, Ward E. Disparities and trends in sentinel lymph node biopsy among early-stage breast cancer patients (1998–2005). J Natl Cancer Inst. 2008;100(7):462–74.
Ingraham AM, **ong W, Hemmila MR, et al. The attributable mortality and length of stay of trauma-related complications: a matched cohort study. Ann Surg. 2010;252(2):358–62.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Acute Care Surg. 1974;14(3):187–96.
Palmer C. Major trauma and the injury severity score-where should we set the bar? In: Paper presented at: Annual Proceedings/Association for the Advancement of Automotive Medicine, 2007.
Armitage P. Tests for linear trends in proportions and frequencies. Biometrics. 1955;11(3):375–86.
Austin PC. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Commun Stat-Simul Comput. 2009;38(6):1228–34.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083–107.
Yoshida K, Hernández-Díaz S, Solomon DH, et al. Matching weights to simultaneously compare three treatment groups: comparison to three-way matching. Epidemiology. 2017;28(3):387.
Haider AH, Hashmi ZG, Zafar SN, et al. Develo** best practices to study trauma outcomes in large databases: an evidence-based approach to determine the best mortality risk adjustment model. J Trauma Acute Care Surg. 2014;76(4):1061–9.
Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989;79(3):340–9.
Newell MA, Bard MR, Goettler CE, et al. Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg. 2007;204(5):1056–61.
Bruijns SR, Guly HR, Bouamra O, Lecky F, Lee WA. The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality. J Trauma Acute Care Surg. 2013;74(6):1432–7.
George RL, McGwin G Jr, Metzger J, Chaudry IH, Rue LW III. The association between gender and mortality among trauma patients as modified by age. J Trauma Acute Care Surg. 2003;54(3):464–71.
Thombs BD, Singh VA, Halonen J, Diallo A, Milner SM. The effects of preexisting medical comorbidities on mortality and length of hospital stay in acute burn injury: evidence from a national sample of 31,338 adult patients. Ann Surg. 2007;245(4):629.
Hardin JW. Generalized estimating equations (GEE). Encyclopedia of statistics in behavioral science. 2005.
Zorn CJ. Generalized estimating equation models for correlated data: A review with applications. Am J Polit Sci. 2001;45:470–90.
O’brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–90.
Bollen KA, Jackman RW. Regression diagnostics: an expository treatment of outliers and influential cases. Sociol Methods Res. 1985;13(4):510–42.
VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167(4):268–74.
Chowdhury M, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94(2):145–61.
Lombardi CP, Raffaelli M, Boniardi M, et al. Adrenocortical carcinoma: effect of hospital volume on patient outcome. Langenbecks Arch Surg. 2012;397(2):201–7.
Lee J-A, Kim S-Y, Park K, Park E-C, Park J-H. Analysis of hospital volume and factors influencing economic outcomes in cancer surgery: Results from a population-based study in Korea. Osong Public Health Res Perspect. 2017;8(1):34.
Slover JD, Tosteson AN, Bozic KJ, Rubash HE, Malchau H. Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am. 2008;90(7):1492.
Hannan EL, Racz M, Ryan TJ, et al. Coronary angioplasty volume-outcome relationships for hospitals and cardiologists. JAMA. 1997;277(11):892–8.
Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res. 2007;457:35–41.
Durairaj L, Torner JC, Chrischilles EA, Sarrazin MSV, Yankey J, Rosenthal GE. Hospital volume-outcome relationships among medical admissions to ICUs. Chest. 2005;128(3):1682–9.
Joynt KE, Orav EJ, Jha AK. The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure. Ann Intern Med. 2011;154(2):94–102.
Vrijens F, Stordeur S, Beirens K, Devriese S, Van Eycken E, Vlayen J. Effect of hospital volume on processes of care and 5-year survival after breast cancer: A population-based study on 25 000 women. The Breast. 2012;21(3):261–6.
Schaefer SD. The acute management of external laryngeal trauma: a 27-year experience. Arch Otolaryngol-Head Neck Surg. 1992;118(6):598–604.
Bailey BJ, Johnson JT, Newlands SD. Head & neck surgery—otolaryngology, vol. 1. Lippincott Williams & Wilkins; 2006.
Flint PW, Haughey BH, Robbins KT, et al. Cummings otolaryngology-head and neck surgery. Elsevier Health Sciences; 2014.
Mendelsohn AH, Sidell DR, Berke GS, John MS. Optimal timing of surgical intervention following adult laryngeal trauma. Laryngoscope. 2011;121(10):2122–7.
Jewett BS, Shockley WW, Rutledge R. External laryngeal trauma analysis of 392 patients. Arch Otolaryngol-Head Neck Surg. 1999;125(8):877–80.
Butler AP, O’Rourke AK, Wood BP, Porubsky ES. Acute external laryngeal trauma: experience with 112 patients. Ann Otol Rhinol Laryngol. 2005;114(5):361–8.
Myssiorek D, Soliman AM. Laryngeal trauma: external approaches. Oper Tech Otolaryngol Head Neck Surg. 2020;31(4):317–23.
Juutilainen M, Vintturi J, Robinson S, Bäck L, Lehtonen H, Mäkitie AA. Laryngeal fractures: clinical findings and considerations on suboptimal outcome. Acta Otolaryngol. 2008;128(2):213–8.
Califf RM, Faxon DP. Need for centers to care for patients with acute coronary syndromes. Circulation. 2003;107(11):1467–70.
Eskander A, Merdad M, Irish JC, et al. Volume–outcome associations in head and neck cancer treatment: A systematic review and meta-analysis. Head Neck. 2014;36(12):1820–34.
American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. American College of Surgeons; 1990.
Vali Y, Rashidian A, Jalili M, Omidvari A, Jeddian A. Effectiveness of regionalization of trauma care services: a systematic review. Public Health. 2017;146:92–107.
Kulkarni GS, Laupacis A, Urbach DR, Fleshner NE, Austin PC. Varied definitions of hospital volume did not alter the conclusions of volume–outcome analyses. J Clin Epidemiol. 2009;62(4):400–7.
Urbach DR, Baxter NN. Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data. BMJ. 2004;328(7442):737–40.
Parast L, Doyle B, Damberg CL, et al. Challenges in assessing the process–outcome link in practice. J Gen Intern Med. 2015;30(3):359–64.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Forner, D., Noel, C.W., Guttman, M.P. et al. Volume-outcome relationships in laryngeal trauma processes of care: a retrospective cohort study. Eur J Trauma Emerg Surg 48, 4131–4141 (2022). https://doi.org/10.1007/s00068-022-01950-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-022-01950-x