Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study

ObjectiveTo explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals.DesignPopulation-based observational study.SettingAll acute hospitals in California, USA.ParticipantsAll individuals aged ≥65 that underwent an operation for an isolated hip fracture...

Full description

Saved in:
Bibliographic Details
Published in:BMJ open 2016-04, Vol.6 (4), p.e010743-e010743
Main Authors: Metcalfe, David, Salim, Ali, Olufajo, Olubode, Gabbe, Belinda, Zogg, Cheryl, Harris, Mitchel B, Perry, Daniel C, Costa, Matthew L
Format: Article
Language:English
Subjects:
Age
Aged
Aged, 80 and over
California
Comorbidity
Female
Femoral Fractures - mortality
Femoral Fractures - therapy
Femur
Fractures
Health Services Research
Hip
hip fracture
Hip Fractures - complications
Hip Fractures - mortality
Hip Fractures - surgery
Hospital Mortality
Hospitalization
Hospitals
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Length of Stay
Male
minimum volume standards
Mortality
Observational studies
Outcome Assessment, Health Care
Patient Readmission
Patients
Quality of Health Care
Sensitivity analysis
Trauma
United States
Variance analysis
volume-outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ObjectiveTo explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals.DesignPopulation-based observational study.SettingAll acute hospitals in California, USA.ParticipantsAll individuals aged ≥65 that underwent an operation for an isolated hip fracture in California between 2007 and 2011. Patients transferred between hospitals were excluded.Primary and secondary outcomesQuality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications).Results91 401 individuals satisfied the inclusion criteria. Time to operation and length of stay were significantly prolonged in low-volume hospitals, by 1.96 (95% CI 1.20 to 2.73) and 0.70 (0.38 to 1.03) days, respectively. However, there were no differences in clinical outcomes, including in-hospital mortality, 30-day re-admission, and rates of pneumonia, pressure ulcers, and venous thromboembolism.ConclusionsThese data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2015-010743