Skip to main content

Advertisement

SpringerLink
Log in

Volume-outcome relationships in laryngeal trauma processes of care: a retrospective cohort study

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References:

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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

  3. Bell RB, Verschueren DS, Dierks EJ. Management of laryngeal trauma. Oral Maxillofac Surg Clin N Am. 2008;20(3):415–30.

    Article  Google Scholar 

  4. Moonsamy P, Sachdeva UM, Morse CR. Management of laryngotracheal trauma. Ann Cardiothorac Surg. 2018;7(2):210–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thevasagayam M, Pracy P. Laryngeal trauma: a systematic approach to management. Trauma. 2005;7(2):87–94.

    Article  Google Scholar 

  6. Lloyd R. Quality health care: a guide to developing and using indicators. Jones & Bartlett Learning; 2017.

  7. Donabedian A. Exploratings in quality assessment and monitoring definition of quality and approaches to its assessment. Ann Arbor. 1980;50:191.

    Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Webster P. Time to evaluate why high-volume hospitals have better surgical outcomes. In: Can Med Assoc; 2005; 173(2):140

  10. Nathens AB, Jurkovich GJ, Maier RV, et al. Relationship between trauma center volume and outcomes. JAMA. 2001;285(9):1164–71.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg. 2007;245(5):777.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Hashmi ZG, Kaji AH, Nathens AB. Practical guide to surgical data sets: National Trauma Data Bank (NTDB). JAMA Surg. 2018;153(9):852–3.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  Google Scholar 

  18. Forner D, Noel CW, Guttman MP, et al. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. The Laryngoscope. 2020; 131(4):E1109–E1116

  19. Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083–91.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Ingraham AM, Xiong 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

  25. Armitage P. Tests for linear trends in proportions and frequencies. Biometrics. 1955;11(3):375–86.

    Article  Google Scholar 

  26. 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.

    Article  Google Scholar 

  27. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Haider AH, Hashmi ZG, Zafar SN, et al. Developing 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.

    Article  PubMed  Google Scholar 

  30. Greenland S. Modeling and variable selection in epidemiologic analysis. Am J Public Health. 1989;79(3):340–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. 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.

    Article  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hardin JW. Generalized estimating equations (GEE). Encyclopedia of statistics in behavioral science. 2005.

  36. Zorn CJ. Generalized estimating equation models for correlated data: A review with applications. Am J Polit Sci. 2001;45:470–90.

    Article  Google Scholar 

  37. O’brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673–90.

    Article  Google Scholar 

  38. Bollen KA, Jackman RW. Regression diagnostics: an expository treatment of outliers and influential cases. Sociol Methods Res. 1985;13(4):510–42.

    Article  Google Scholar 

  39. VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167(4):268–74.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  PubMed  Google Scholar 

  42. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hannan EL, Racz M, Ryan TJ, et al. Coronary angioplasty volume-outcome relationships for hospitals and cardiologists. JAMA. 1997;277(11):892–8.

    Article  CAS  PubMed  Google Scholar 

  45. Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res. 2007;457:35–41.

    Article  PubMed  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. Schaefer SD. The acute management of external laryngeal trauma: a 27-year experience. Arch Otolaryngol-Head Neck Surg. 1992;118(6):598–604.

    Article  CAS  PubMed  Google Scholar 

  50. Bailey BJ, Johnson JT, Newlands SD. Head & neck surgery—otolaryngology, vol. 1. Lippincott Williams & Wilkins; 2006.

    Google Scholar 

  51. Flint PW, Haughey BH, Robbins KT, et al. Cummings otolaryngology-head and neck surgery. Elsevier Health Sciences; 2014.

    Google Scholar 

  52. Mendelsohn AH, Sidell DR, Berke GS, John MS. Optimal timing of surgical intervention following adult laryngeal trauma. Laryngoscope. 2011;121(10):2122–7.

    Article  PubMed  Google Scholar 

  53. Jewett BS, Shockley WW, Rutledge R. External laryngeal trauma analysis of 392 patients. Arch Otolaryngol-Head Neck Surg. 1999;125(8):877–80.

    Article  CAS  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. Myssiorek D, Soliman AM. Laryngeal trauma: external approaches. Oper Tech Otolaryngol Head Neck Surg. 2020;31(4):317–23.

    Article  Google Scholar 

  56. 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.

    Article  PubMed  Google Scholar 

  57. Califf RM, Faxon DP. Need for centers to care for patients with acute coronary syndromes. Circulation. 2003;107(11):1467–70.

    Article  PubMed  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

  59. American College of Surgeons Committee on Trauma. Resources for optimal care of the injured patient. American College of Surgeons; 1990.

    Google Scholar 

  60. 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.

    Article  CAS  PubMed  Google Scholar 

  61. 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.

    Article  PubMed  Google Scholar 

  62. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  63. 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.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

  1. Avery B. Nathens and Antoine Eskander are Co-Senior Authorship.

Authors and Affiliations

  1. Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada

    David Forner, Matthew H. Rigby & S. Mark Taylor

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    David Forner, Christopher W. Noel, Matthew P. Guttman, Barbara Haas, Danny Enepekides, Avery B. Nathens & Antoine Eskander

  3. Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada

    Christopher W. Noel, Danny Enepekides & Antoine Eskander

  4. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Matthew P. Guttman, Barbara Haas & Avery B. Nathens

  5. Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Barbara Haas & Avery B. Nathens

  6. Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, ON, M4N 3M5, Canada

    Danny Enepekides & Antoine Eskander

  7. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Barbara Haas

Authors
  1. David Forner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher W. Noel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew P. Guttman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Haas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danny Enepekides
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthew H. Rigby
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Mark Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Avery B. Nathens
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Antoine Eskander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antoine Eskander.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 59 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-01950-x

keywords

Search

Navigation