The Effect of Preexisting Medical Comorbidities on Trauma Outcomes in Milwaukee, Wisconsin: A Retrospective Hospital Database Review

Abstract

Background: Traumatic injuries are a major public health challenge worldwide. The proportion of trauma patients with preexisting medical comorbidity has increased dramatically in recent years due to the aging population. While most studies agree on the negative effect of comorbidities on mortality rates, focusing only on mortality excludes the 95% of trauma cases that survive. Few studies, if any, have examined hospital lengths of stay for trauma patients with different comorbidities. Methods: This retrospective study included trauma patients who were admitted to Froedtert Hospital (Milwaukee, WI, USA) in the period between 2015 to 2023. A total of 8,365 patients were included. Preexisting medical comorbidities effect on length of hospital stay, intensive care unit (ICU) stay, and ventilator use status were examined using multiple logistic regression for categorical variables, and analysis of covariance (ANCOVA) for numerical variables. All results were adjusted for potential confounders (age, gender, injury type, and Injury Severity Score) Results: Medical comorbidities significantly increased the hospital length of stay by an average of 1.42 days. Obesity had the greatest effect, adding 4.36 days, followed by cardiovascular disease at 3.13 days. Other comorbidities also showed significant association, ranging from 1 to 3 additional days. Additionally, medical comorbidities significantly increased ICU stay by an average of 0.27 days. Again, obesity had the greatest effect, adding 1.43 days, followed by substance and drug use disorders at 0.76 days. Other comorbidities showed significant associations of 0.5 to 1 additional days. However, medical comorbidities were not associated with a significant increase in ventilator use status or duration, except for substance and drug use disorders, which increased the odds of ventilator use by 30%, and obesity, which increased the duration of ventilator use by 0.79 days. Conclusion: Medical comorbidities significantly affect hospital length of stay and intensive care unit stay. Management protocols for trauma patients with comorbidities that include comprehensive, multidisciplinary teams to assist with comorbidity management may improve outcomes and reduce costs. Further research is needed to examine the outcome effects of individual comorbidities and the best ways to manage them.