Z.H. Hodges1, D. Neal1, E. Vanzant1, C. Johnson-Mann1, J. Taylor1 1University of Florida, Department Of Surgery, Gainesville, FL, USA
Introduction:
Hemorrhagic shock in trauma is a common cause of mortality, especially when describing intraoperative deaths in the acute posttraumatic period. Certain injury patterns (e.g. solid organ hemorrhage from pseudoaneurysm) predispose to hemorrhage, yet are amenable to timely intervention. The protocolized use of a hybrid trauma operating room (OR) furnished to provide angiographic capabilities in addition to standard operative exploration may yield improved patient outcomes; however, more study is needed to understand which trauma patient subpopulations would benefit most from widespread adoption of these facilities.
Methods:
This single-center, retrospective study examined outcomes following laparotomy in 849 trauma patients treated before (n = 403) and after (n = 446) implementation of a trauma hybrid OR with angiographic capability at an academic Level 1 Trauma Center. Logistic and linear regression were used to assess the effect of protocolized use of trauma hybrid OR vs. historic controls on mortality and hospital length of stay (hLOS) when adjusting for age, gender, BMI, and injury severity score (ISS).
Results:
The hybrid and control cohorts included patients with similar demographics (average age 45 vs. 42 years, 71% vs. 72% male, respectively), but significantly different ISS (mean 21.6 vs. 26, p <.001). The hybrid cohort had significantly lower all-cause mortality in univariate analysis (11% vs. 16% in control, p = .02), but only a trend toward lower mortality after risk adjustment (OR=0.8, 95CI 0.5-1.3, p=.8). The post-protocol group had longer LOS on both univariate analysis (median LOS 11 days vs. 7 days in control, p<.0001) and after risk adjustment (LOS 38% higher than control, 95CI 22%-55%, p<.0001).
Conclusion:
Protocolized implementation of a trauma hybrid OR is associated with increased hospital length of stay among trauma laparotomy patients. The hybrid cohort had significantly lower all-cause mortality in univariate analysis, but only a trend toward lower mortality after risk adjustment. More study is needed to further elucidate the association of trauma hybrid OR use and trauma patient mortality.