Associations between cardiovascular comorbidities and mortality, length of hospital stay, and total charges among traumatic injury patients

  • Michael Yang
  • R. David HaywardEmail author
  • Elango Edhayan
Original Article



Cardiovascular conditions are highly prevalent and particularly common in subsets of the population at high risk for traumatic injury. This study evaluates the extent to which cardiovascular comorbidity may increase risks of negative outcomes in patients receiving trauma treatment.


Clinical data for all patients admitted for traumatic injury (defined by ICD-9 diagnosis codes) of all levels of severity between the years of 2006 and 2014 in the Detroit USA metropolitan area were obtained from the State Inpatient Database for Michigan. The association between four types of cardiovascular comorbidity (hypertension, congestive heart failure, pulmonary circulation disorders, and valvular heart disease), and three outcomes (mortality, length of hospital stay, and total charges), was assessed using generalized linear modeling, both alone and after controlling for injury severity, injury region, and demographic factors.


All four comorbidities examined were related to worse outcomes on all three dimensions. The greatest magnitude of estimated effects with each outcome was associated with pulmonary circulation disorders (mortality OR = 2.99, length of stay IRR = 1.69, hospital charges IRR = 1.76), and the smallest magnitude of estimated effects was associated with hypertension (mortality OR = 1.20, length of stay IRR = 1.20, hospital charges IRR = 1.18). After adjustment for the presence of multiple comorbidities, injury severity and region, age, gender, and race, all effect estimates remained significant and in the same direction, except valvular heart disease which was unrelated to mortality, and hypertension was related to lower risk of mortality (OR = 0.76).


Cardiovascular comorbidities are related to higher risk of negative outcomes among patients hospitalized due to traumatic injury. Screening for these comorbidities on admission may help to improve patient outcomes.


Cardiovascular health Traumatic injury Risk factors Mortality 


Compliance with ethical standards

Conflict of interest

Michael Yang, R. David Hayward, and Elango Edhayan declare that they have no conflict of interest.


  1. 1.
    World Health Organization. Injuries and violence: the facts. Geneva: WHO; 2014.Google Scholar
  2. 2.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal Injury Data [Internet]. 2017. Accessed 21 Sep 2018.
  3. 3.
    Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing Trauma Deaths in the United States. Ann Surg. 2014;260:13–21.CrossRefGoogle Scholar
  4. 4.
    DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C, Marshall G, Lee DC, et al. Traumatic injury in the United States: in-patient epidemiology 2000–2011. Injury. 2016;47:1393–403.CrossRefGoogle Scholar
  5. 5.
    Abubakar II, Tillmann T, Banerjee A. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71.CrossRefGoogle Scholar
  6. 6.
    Markwardt S, Quiñones AR, Botoseneanu A. Multimorbidity combinations and disability in older adults. J Gerontol Ser A. 2016;71:823–30.CrossRefGoogle Scholar
  7. 7.
    Afaneh A, Ford J, Gharzeddine J, Mazar A, Hayward RD, Buck J. Head injury on Warfarin: likelihood of delayed intracranial bleeding in patients with negative initial head CT. BMC Res Notes. 2018;11:183.CrossRefGoogle Scholar
  8. 8.
    Dossett LA, Riesel JN, Griffin MR, Cotton BA. Prevalence and implications of preinjury warfarin use: an analysis of the national trauma Databank prevalence and implications of preinjury warfarin. Arch Surg. 2011;146:565–70.CrossRefGoogle Scholar
  9. 9.
    Maxwell CA, Patel MB, Suarez-Rodriguez LC, Miller RS. Frailty and Prognostication in Geriatric Surgery and Trauma. Clin Geriatr Med. 2019;35:13–26.CrossRefGoogle Scholar
  10. 10.
    Härstedt M, Rogmark C, Sutton R, Melander O, Fedorowski A. Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery. Injury. 2015;46:713–8.CrossRefGoogle Scholar
  11. 11.
    Roche JJW, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331:1374.CrossRefGoogle Scholar
  12. 12.
    Brown CVR, Rix K, Klein AL, Ford B, Teixeira PGR, Aydelotte J, et al. A comprehensive investigation of comorbidities, mechanisms, injury patterns, and outcomes in geriatric blunt trauma patients. Am Surg. 2016;82:1055–62.PubMedGoogle Scholar
  13. 13.
    Scheetz LJ. Relationship of age, injury severity, injury type, comorbid conditions, level of care, and survival among older motor vehicle trauma patients. Res Nurs Health. 2005;28:198–209.CrossRefGoogle Scholar
  14. 14.
    Healthcare Cost and Utilization Project. HCUP State Inpatient Databases (SID) [Internet]. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed 15 June 2019.
  15. 15.
    Greene NH, Kernic MA, Vavilala MS, Rivara FP. Validation of ICDPIC software injury severity scores using a large regional trauma registry. Inj Prev. 2015;21:325.CrossRefGoogle Scholar
  16. 16.
    Clark DE, Black AW, Skavdahl DH, Hallagan LD. Open-access programs for injury categorization using ICD-9 or ICD-10. Inj Epidemiol. 2018;5:11–11.CrossRefGoogle Scholar
  17. 17.
    London MJ, Schwartz GG, Hur K, Henderson WG. Association of perioperative statin use with mortality and morbidity after major noncardiac surgery association of perioperative statin use with mortality and morbidity association of perioperative statin use with mortality and morbidity. JAMA Intern Med. 2017;177:231–42.CrossRefGoogle Scholar
  18. 18.
    Jansen JO, Lord JM, Thickett DR, Midwinter MJ, McAuley DF, Gao F. Clinical review: statins and trauma a systematic review. Crit Care. 2013;17:227.CrossRefGoogle Scholar
  19. 19.
    Wible EF, Laskowitz DT. Statins in traumatic brain injury. Neurotherapeutics. 2010;7:62–73.CrossRefGoogle Scholar
  20. 20.
    Eberhardt MS, Fryar CD, Hirsch R, Wright JD, Yoon SSug. Hypertension, high serum total cholesterol, and diabetes; racial and ethnic prevalence differences in U.S. adults, 1999–2006. National Center for Health Statistics (U.S.), editor. 2010. Accessed 18 June 2019.
  21. 21.
    Quintana JM, González N, Bilbao A, Aizpuru F, Escobar A, Esteban C, et al. Predictors of patient satisfaction with hospital health care. BMC Health Serv Res. 2006;6:102.CrossRefGoogle Scholar
  22. 22.
    Tsai TC, Orav EJ, Jha AK. Patient satisfaction and quality of surgical care in US hospitals. Ann Surg. 2015;261:2–8.CrossRefGoogle Scholar
  23. 23.
    Khanna S, Boyle J, Good N, Lind J. Unravelling relationships: Hospital occupancy levels, discharge timing and emergency department access block. Emerg Med Australas. 2012;24:510–7.CrossRefGoogle Scholar
  24. 24.
    Powell ES, Khare RK, Venkatesh AK, Van Roo BD, Adams JG, Reinhardt G. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2012;42:186–96.CrossRefGoogle Scholar
  25. 25.
    Wakeam E, Molina G, Shah N, Lipsitz SR, Chang DC, Gawande AA, et al. Variation in the cost of 5 common operations in the United States. Surgery. 2017;162:592–604.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryAscension St. John HospitalDetroitUSA

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