BACKGROUND: Large regional hospitals achieve good outcomes for patients with complex conditions. However, recent studies have suggested that some patient groups might not benefit from treatment in higher-level trauma centers. OBJECTIVE: To test the hypothesis that older adults with isolated hip fractures experience delayed surgical treatment and worse clinical outcomes when treated in higher-level trauma centers. RESEARCH DESIGN: Retrospective cohort study using a statewide longitudinal database that captured 98% of inpatients within California (2007-2011). SUBJECTS: All older adults (aged 65 y and above) admitted with an isolated hip fracture who did not require interhospital transfer. MEASURES: Days to operation, length of stay, inhospital mortality, 30-day risk of unplanned readmission, 30-day venous thromboembolism, decubitus ulcers, and pneumonia. RESULTS: There were 91,401 patients, 6.1% of whom were treated in a level 1 trauma center (L1TC), 17.7% in a level 2 trauma center (L2TC), and 70.2% in a nontrauma center (NTC). Within multivariable logistic and generalized linear regression models, patients treated in L1TCs underwent surgery later (predicted mean difference: 0.30 d; 95% CI, 0.08-0.53), had prolonged inpatient stays (0.99 d, 0.40-1.59), and had higher odds of both 30-day readmission (aOR=1.62; 95% CI, 1.35-1.93) and venous thromboembolism (aOR=1.32, 1.01-1.74) relative to NTCs. There were no differences in mortality, decubitus ulcers, or pneumonias. L2TCs were not different from NTCs across any of the measured outcomes. CONCLUSIONS: Older adults with hip fractures may be disadvantaged in L1TCs. Further research should aim to develop our understanding of this disparity to ensure that all patient groups benefit from the resources and expertise available within these hospitals.
BACKGROUND: Large regional hospitals achieve good outcomes for patients with complex conditions. However, recent studies have suggested that some patient groups might not benefit from treatment in higher-level trauma centers. OBJECTIVE: To test the hypothesis that older adults with isolated hip fractures experience delayed surgical treatment and worse clinical outcomes when treated in higher-level trauma centers. RESEARCH DESIGN: Retrospective cohort study using a statewide longitudinal database that captured 98% of inpatients within California (2007-2011). SUBJECTS: All older adults (aged 65 y and above) admitted with an isolated hip fracture who did not require interhospital transfer. MEASURES: Days to operation, length of stay, inhospital mortality, 30-day risk of unplanned readmission, 30-day venous thromboembolism, decubitus ulcers, and pneumonia. RESULTS: There were 91,401 patients, 6.1% of whom were treated in a level 1 trauma center (L1TC), 17.7% in a level 2 trauma center (L2TC), and 70.2% in a nontrauma center (NTC). Within multivariable logistic and generalized linear regression models, patients treated in L1TCs underwent surgery later (predicted mean difference: 0.30 d; 95% CI, 0.08-0.53), had prolonged inpatient stays (0.99 d, 0.40-1.59), and had higher odds of both 30-day readmission (aOR=1.62; 95% CI, 1.35-1.93) and venous thromboembolism (aOR=1.32, 1.01-1.74) relative to NTCs. There were no differences in mortality, decubitus ulcers, or pneumonias. L2TCs were not different from NTCs across any of the measured outcomes. CONCLUSIONS: Older adults with hip fractures may be disadvantaged in L1TCs. Further research should aim to develop our understanding of this disparity to ensure that all patient groups benefit from the resources and expertise available within these hospitals.
Authors: Katie J Sheehan; Boris Sobolev; Pierre Guy; Lisa Kuramoto; Suzanne N Morin; Jason M Sutherland; Lauren Beaupre; Donald Griesdale; Michael Dunbar; Eric Bohm; Edward Harvey Journal: CMAJ Date: 2016-10-17 Impact factor: 8.262
Authors: Boris Sobolev; Pierre Guy; Katie Jane Sheehan; Lisa Kuramoto; Jason M Sutherland; Adrian R Levy; James A Blair; Eric Bohm; Jason D Kim; Edward J Harvey; Suzanne N Morin; Lauren Beaupre; Michael Dunbar; Susan Jaglal; James Waddell Journal: CMAJ Date: 2018-08-07 Impact factor: 8.262
Authors: Boris Sobolev; Pierre Guy; Katie J Sheehan; Eric Bohm; Lauren Beaupre; Suzanne N Morin; Jason M Sutherland; Michael Dunbar; Donald Griesdale; Susan Jaglal; Lisa Kuramoto Journal: Medicine (Baltimore) Date: 2017-04 Impact factor: 1.889
Authors: Sara Marie Nilsen; Andreas Asheim; Fredrik Carlsen; Kjartan Sarheim Anthun; Lars Gunnar Johnsen; Lars Johan Vatten; Johan Håkon Bjørngaard Journal: Bone Joint J Date: 2021-02 Impact factor: 5.082
Authors: Jordan B Pasternack; Matthew L Ciminero; Michael Silver; Joseph Chang; Piyush Gupta; Kevin K Kang Journal: Geriatr Orthop Surg Rehabil Date: 2020-03-16