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...

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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
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cited_by cdi_FETCH-LOGICAL-b508t-c26e27f0fdcf8b1236c2e59f28c1dcaf0d38f0dcee6d8c1b8dfa7c375ab43cb33
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container_end_page e010743
container_issue 4
container_start_page e010743
container_title BMJ open
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creator Metcalfe, David
Salim, Ali
Olufajo, Olubode
Gabbe, Belinda
Zogg, Cheryl
Harris, Mitchel B
Perry, Daniel C
Costa, Matthew L
description 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.
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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.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2015-010743</identifier><identifier>PMID: 27056592</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>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</subject><ispartof>BMJ open, 2016-04, Vol.6 (4), p.e010743-e010743</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b508t-c26e27f0fdcf8b1236c2e59f28c1dcaf0d38f0dcee6d8c1b8dfa7c375ab43cb33</citedby><cites>FETCH-LOGICAL-b508t-c26e27f0fdcf8b1236c2e59f28c1dcaf0d38f0dcee6d8c1b8dfa7c375ab43cb33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2663123741/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2663123741?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,723,776,780,881,3181,25731,27526,27527,27901,27902,36989,36990,44566,53766,53768,55316,55325,74869,77336,77337,77338,77339,77343,77374,77402,77428</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27056592$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Metcalfe, David</creatorcontrib><creatorcontrib>Salim, Ali</creatorcontrib><creatorcontrib>Olufajo, Olubode</creatorcontrib><creatorcontrib>Gabbe, Belinda</creatorcontrib><creatorcontrib>Zogg, Cheryl</creatorcontrib><creatorcontrib>Harris, Mitchel B</creatorcontrib><creatorcontrib>Perry, Daniel C</creatorcontrib><creatorcontrib>Costa, Matthew L</creatorcontrib><title>Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><addtitle>BMJ Open</addtitle><description>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. 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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.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>27056592</pmid><doi>10.1136/bmjopen-2015-010743</doi><oa>free_for_read</oa></addata></record>
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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
title Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study
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