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Rural Trauma Team Development Course Decreases Transfer Times
Vol. 221, No. 4S1, October 2015
comorbidity status, non-Medicaid insurance, discharge to home, and Hartmann’s resection performed by a high-volume colorectal surgeon or hospital. After controlling for patient, surgeon, and hospital characteristics, high surgeon and/or hospital volume were independently associated with a laparoscopic approach, shorter length of stay, and lower rates of ICU admission, 30-day readmission, and 90day mortality after stoma reversal (Table). CONCLUSIONS: Although regional damage control Hartmann’s procedure capabilities must remain, these findings suggest that stoma reversal should be managed by high-volume surgeons and hospitals. Rural Trauma Team Development Course Decreases Transfer Times Vicente J Undurraga Perl, MD, Bruce Ham, MD, Amy Laird, PhD, Richard J Mullins, MD, FACS, Brian S Diggs, PhD, Martin A Schreiber, MD, FACS Oregon Health and Science University, Portland, OR INTRODUCTION: The Rural Trauma Team Development Course (RTTDC) aims to identify local limitations in the care of injured rural patients, with an emphasis on an early decision to transfer for patients requiring a higher level of care. We hypothesized that the RTTDC would result in a decreased time from arrival to decision to transfer. METHODS: The state’s trauma registry was accessed from 2006 to 2013, and all transferred patients in hospitals that took the RTTDC were identified. After assessing baseline characteristics, a Cox proportional hazards model was used to estimate the hazard ratio of time to decision to transfer, after the RTTDC vs before. RESULTS: There were 4,430 transferred trauma patients; 2,793 cases had time to decision to transfer recorded. No major differences in age, sex, mechanism of injury, Injury Severity Score (ISS), or Glasgow Coma Scale (GCS) were noted between patients treated before and after the RTTDC. The median time from arrival to decision to transfer decreased from 103 to 90 minutes after the RTTDC (p¼0.008) and the median hospital length of stay decreased from 155 to 146 minutes (p¼0.001). After exposure to the RTTDC, transferred patients exhibited a hazard ratio of 1.24 (95% CI, 1.14, 1.35) of having the decision to transfer made at each time point compared to before; controlling for ISS, presence of hypotension, GCS, and admission hospital. CONCLUSIONS: These data support the conclusion that personnel in rural trauma centers who are exposed to the RTTDC make the decision to transfer more quickly. The RTTDC is an effective training process. Understanding the Relationship Between 30- and 90-Day Emergency Room Visits, Readmissions, and Complications after Radical Cystectomy E Sophie Spencer, MD, Matthew D Lyons, MD, Peter Greene, MD, Anne Marie Meyer, PhD, Ke Meng, PhD, Matthew E Nielsen, MD, FACS, Eric M Wallen, MD, FACS, Michael E Woods, MD, FACS, Raj S Pruthi, MD, FACS, Angela B Smith, MD University of North Carolina, Chapel Hill, NC
Scientific Forum Abstracts
S135
INTRODUCTION: Readmissions are common after radical cystectomy (RC) for bladder cancer. Our objective was to determine the frequency of emergency room (ER) visits and readmissions within 30 and 90 days after RC for bladder cancer and identify complications associated with early and late readmissions. METHODS: Using a linked data resource combining North Carolina Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients diagnosed with bladder cancer from 2003 to 2010 who received RC. We identified complications, readmissions, and ER visits 30 and 31 to 90 days after discharge. Comparisons between 30- and 90-day readmissions and ER visits were performed using the chi-square test. RESULTS: A total of 785 patients were identified as having received RC for bladder cancer with continuous enrollment, with 310 (39%) experiencing at least 1 readmission within 90 days. Of the 472 patients who were not readmitted, 68 (14%) visited the emergency room within 90 days. Of those readmitted, 81% were male and 47% were between 65 and 74 years old. Demographics were similar for those patients presenting to the ER without readmission. An equal proportion of patients were readmitted within 30 and 31 to 90 days (Table). Approximately 29% of those readmitted within 30 days were also readmitted at 31 to 90 days. Complications occurring in association with 30-day readmissions included gastrointestinal, wound, and venous complications; complications associated with 31- to 90-day readmissions included genitourinary, renal, cardiac, and neurologic complications. CONCLUSIONS: An equal proportion of readmissions and ER visits occur within 30 and 90 days after RC for bladder cancer with 25% to 30% being readmitted at both time points. Urban and Pediatric Hospitals Are Associated with Lower Risk of Anesthesia-Related Complications Morgan K Richards, MD, Jarod McAteer, MD, Lynn Martin, Keith T Oldham, MD, FACS, Adam B Goldin, MD, FACS Seattle Children’s Hospital, Seattle, WA, University of Washington, Seattle, WA INTRODUCTION: Health care delivery has shifted from local to regionalized centers. This increases travel burden for rural families, but the improvement in outcomes for these patients remains in question. We hypothesized that pediatric patients receiving care at urban and pediatric centers would have fewer anesthesia and pulmonary complications than those at rural hospitals. METHODS: We performed a retrospective cohort study using the Health Care Cost and Utilization Project Kids’ Inpatient Database from 2006, 2009, and 2012. Adjusted, weighted logistic regression compared anesthesia and pulmonary complications of children treated at urban general adult and pediatric hospitals with those treated at rural hospitals for an operation related to one of the following diagnoses: pyloric stenosis, acute appendicitis, gastroschisis, intussusception, feeding intolerance, malrotation with volvulus, and necrotizing enterocolitis. RESULTS: There were a total of 237,474 discharges that had one of these diagnoses and related operation; 38.3% were female, and
comorbidity status, non-Medicaid insurance, discharge to home, and Hartmann’s resection performed by a high-volume colorectal surgeon or hospital. After controlling for patient, surgeon, and hospital characteristics, high surgeon and/or hospital volume were independently associated with a laparoscopic approach, shorter length of stay, and lower rates of ICU admission, 30-day readmission, and 90day mortality after stoma reversal (Table). CONCLUSIONS: Although regional damage control Hartmann’s procedure capabilities must remain, these findings suggest that stoma reversal should be managed by high-volume surgeons and hospitals. Rural Trauma Team Development Course Decreases Transfer Times Vicente J Undurraga Perl, MD, Bruce Ham, MD, Amy Laird, PhD, Richard J Mullins, MD, FACS, Brian S Diggs, PhD, Martin A Schreiber, MD, FACS Oregon Health and Science University, Portland, OR INTRODUCTION: The Rural Trauma Team Development Course (RTTDC) aims to identify local limitations in the care of injured rural patients, with an emphasis on an early decision to transfer for patients requiring a higher level of care. We hypothesized that the RTTDC would result in a decreased time from arrival to decision to transfer. METHODS: The state’s trauma registry was accessed from 2006 to 2013, and all transferred patients in hospitals that took the RTTDC were identified. After assessing baseline characteristics, a Cox proportional hazards model was used to estimate the hazard ratio of time to decision to transfer, after the RTTDC vs before. RESULTS: There were 4,430 transferred trauma patients; 2,793 cases had time to decision to transfer recorded. No major differences in age, sex, mechanism of injury, Injury Severity Score (ISS), or Glasgow Coma Scale (GCS) were noted between patients treated before and after the RTTDC. The median time from arrival to decision to transfer decreased from 103 to 90 minutes after the RTTDC (p¼0.008) and the median hospital length of stay decreased from 155 to 146 minutes (p¼0.001). After exposure to the RTTDC, transferred patients exhibited a hazard ratio of 1.24 (95% CI, 1.14, 1.35) of having the decision to transfer made at each time point compared to before; controlling for ISS, presence of hypotension, GCS, and admission hospital. CONCLUSIONS: These data support the conclusion that personnel in rural trauma centers who are exposed to the RTTDC make the decision to transfer more quickly. The RTTDC is an effective training process. Understanding the Relationship Between 30- and 90-Day Emergency Room Visits, Readmissions, and Complications after Radical Cystectomy E Sophie Spencer, MD, Matthew D Lyons, MD, Peter Greene, MD, Anne Marie Meyer, PhD, Ke Meng, PhD, Matthew E Nielsen, MD, FACS, Eric M Wallen, MD, FACS, Michael E Woods, MD, FACS, Raj S Pruthi, MD, FACS, Angela B Smith, MD University of North Carolina, Chapel Hill, NC
Scientific Forum Abstracts
S135
INTRODUCTION: Readmissions are common after radical cystectomy (RC) for bladder cancer. Our objective was to determine the frequency of emergency room (ER) visits and readmissions within 30 and 90 days after RC for bladder cancer and identify complications associated with early and late readmissions. METHODS: Using a linked data resource combining North Carolina Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients diagnosed with bladder cancer from 2003 to 2010 who received RC. We identified complications, readmissions, and ER visits 30 and 31 to 90 days after discharge. Comparisons between 30- and 90-day readmissions and ER visits were performed using the chi-square test. RESULTS: A total of 785 patients were identified as having received RC for bladder cancer with continuous enrollment, with 310 (39%) experiencing at least 1 readmission within 90 days. Of the 472 patients who were not readmitted, 68 (14%) visited the emergency room within 90 days. Of those readmitted, 81% were male and 47% were between 65 and 74 years old. Demographics were similar for those patients presenting to the ER without readmission. An equal proportion of patients were readmitted within 30 and 31 to 90 days (Table). Approximately 29% of those readmitted within 30 days were also readmitted at 31 to 90 days. Complications occurring in association with 30-day readmissions included gastrointestinal, wound, and venous complications; complications associated with 31- to 90-day readmissions included genitourinary, renal, cardiac, and neurologic complications. CONCLUSIONS: An equal proportion of readmissions and ER visits occur within 30 and 90 days after RC for bladder cancer with 25% to 30% being readmitted at both time points. Urban and Pediatric Hospitals Are Associated with Lower Risk of Anesthesia-Related Complications Morgan K Richards, MD, Jarod McAteer, MD, Lynn Martin, Keith T Oldham, MD, FACS, Adam B Goldin, MD, FACS Seattle Children’s Hospital, Seattle, WA, University of Washington, Seattle, WA INTRODUCTION: Health care delivery has shifted from local to regionalized centers. This increases travel burden for rural families, but the improvement in outcomes for these patients remains in question. We hypothesized that pediatric patients receiving care at urban and pediatric centers would have fewer anesthesia and pulmonary complications than those at rural hospitals. METHODS: We performed a retrospective cohort study using the Health Care Cost and Utilization Project Kids’ Inpatient Database from 2006, 2009, and 2012. Adjusted, weighted logistic regression compared anesthesia and pulmonary complications of children treated at urban general adult and pediatric hospitals with those treated at rural hospitals for an operation related to one of the following diagnoses: pyloric stenosis, acute appendicitis, gastroschisis, intussusception, feeding intolerance, malrotation with volvulus, and necrotizing enterocolitis. RESULTS: There were a total of 237,474 discharges that had one of these diagnoses and related operation; 38.3% were female, and