Impact of Individual Physicians On Outcomes After Trauma: Is It The System Or The Surgeon?

Objective: Benchmarking of mortality outcomes across the country has revealed major differences in survival based on the trauma center at which a patient receives care. Most believe that these differences in outcomes are... [ view full abstract ]

Objective: Benchmarking of mortality outcomes across the country has revealed major differences in survival based on the trauma center at which a patient receives care. Most believe that these differences in outcomes are primarily driven by system- and process-based variations. Our objective was to determine if variation in individual surgeon outcomes could help explain difference in survival after trauma.

Methods: Analysis of trauma patients in Florida State Inpatient Database from 2010-2014. The presence of unique physician identifiers, in addition to hospital identifiers, rendered this data set ideal for performance of multi-level analysis. The amount of the variation attributable to surgeon-level variation was calculated using multi-level random effects models controlling for patient clinical factors (such as injury severity and comorbidities/age) and hospital-level factors, such as trauma center status and bed size.

Results: There were 29 trauma centers, 175 surgeons, and 65,706 admissions. The overall mortality rate was 5.9%. The average mortality rate across surgeons ranged from 0 to 20.3% (mean 0.4%, SD 1.85). At the individual surgeon level, when controlling for clinical and hospital-level factors, 22.3% of this variation was attributable to the surgeon.

Conclusion: At the state level, we found that differences in outcomes among trauma centers are impacted by individual surgeon-level variation.