• Louis J Magnotti, Sai Krishna Bhogadi, Tanya Anand, Collin Stewart, Christina Colosimo, Audrey L Spencer, Adam Nelson, and Bellal Joseph.
• Department of Surgery, Division of Trauma, Critical Care, Burns, and Emergency Surgery, College of Medicine, University of Arizona, Tucson, AZ.
• Ann. Surg. 2024 Oct 1; 280 (4): 667675667-675.

ObjectiveThis study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC).BackgroundAlthough ATV is a hard criterion for TC verification, importance of procedural interventions as a potential quality indicator is understudied.MethodsPatients managed at ACS level I TCs were identified from ACS-TQIP 2017-2021. TCs were identified using facility keys and stratified into quartiles based on ATV into low, low-medium, medium-high, and high volume. TCs were also stratified into tertiles [low (LV), medium (MV), high (HV)] based on procedural volume by assessing annual number of laparotomies, thoracotomies, craniotomies/craniectomies, angioembolizations, vascular repairs, and long bone fixations performed at each center. The Cohen κ statistic was used to assess concordance between ATV and procedural volume.ResultsA total of 182 Level I TCs were identified: 76 low, 47 low-medium, 35 high-medium, and 24 high volume. Long bone fixation, laparotomy, and craniotomy/craniectomy were the most performed procedures with a median of 65, 59, and 46 cases/center/year, respectively. Overall, 31% of HV laparotomy centers, 31% of HV thoracotomy centers, 22% of HV craniotomy/craniectomy centers, 22% of HV vascular repair centers, 32% of HV long bone fixation centers, and 33% of HV angioembolization centers contributed to the overall number of low-medium and low-volume TCs. The Cohen κ statistic demonstrated poor concordance between ATV and procedural volumes for all procedures (overall procedural volume-κ=0.378, laparotomy-κ=0.270, thoracotomy-κ=0.202, craniotomy/craniectomy-κ=0.394, vascular repair-κ=0.298, long bone fixation-κ=0.277, angioembolization-κ=0.286).ConclusionsATV does not reflect the procedural interventions performed. Combination of procedural and ATV may provide a more accurate picture of the clinical experience at any given TC.Level Of EvidenceLevel III.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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