Surgical subspecialization is associated with higher rate of rib fracture stabilization: a retrospective database analysis

Trauma Surgery & Acute Care Open

article

Avanti Badrinathan¹  Anuja L Sarode¹  Christine E Alvarado¹  Jillian Sinopoli²  Jonathan D Rice²  Philip A Linden²  Matthew L Moorman³  Christopher W Towe² 

[1] Department of Surgery , University Hospitals Cleveland Medical Center;Division of Thoracic and Esophageal Surgery , University Hospitals Cleveland Medical Center;Division of Trauma and Acute Care Surgery , University Hospitals Cleveland Medical Center

关键词: rib fractures;    Practice Patterns;    Physicians';   

DOI  :  10.1136/tsaco-2022-000994

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Surgical stabilization of rib fractures (SSRF) is performed on only a small subset of patients who meet guideline-recommended indications for surgery. Although previous studies show that provider specialization was associated with SSRF procedural competency, little is known about the impact of provider specialization on SSRF performance frequency. We hypothesize that provider specialization would impact performance of SSRF.Methods The Premier Hospital Database was used to identify adult patients with rib fractures from 2015 and 2019. The outcome of interest was performance of SSRF, defined using International Classification of Diseases—10th Revision Procedure Coding System coding. Patients were categorized as receiving their procedures from a thoracic, general surgeon, or orthopedic surgeon. Patients with missing or other provider types were excluded. Multivariate modeling was performed to evaluate the effect of surgical specialization on outcomes of SSRF. Given a priori assumptions that trauma centers may have different practice patterns, a subgroup analysis was performed excluding patients with ‘trauma center’ admissions.Results Among 39 733 patients admitted with rib fractures, 2865 (7.2%) received SSRF. Trauma center admission represented a minority (1034, 36%) of SSRF procedures relative to other admission types (1831, 64%, p=0.15). In a multivariable analysis, thoracic (OR 6.94, 95% CI 5.94–8.11) and orthopedic provider (OR 2.60, 95% CI 2.16–3.14) types were significantly more likely to perform SSRF. In further analyses of trauma center admissions versus non-trauma center admissions, this pattern of SSRF performance was found at non-trauma centers.Conclusion The majority of SSRF procedures in the USA are being performed by general surgeons and at non-trauma centers. ‘Subspecialty’ providers in orthopedics and thoracic surgery are performing fewer total SSRF interventions, but are more likely to perform SSRF, especially at non-trauma centers. Provider specialization as a barrier to SSRF may be related to competence in the SSRF procedures and requires further study.Type Therapeutic/care management.

【 授权许可】

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