Does Hospital Experience Rather than Volume Improve Outcomes in Geriatric Trauma Patients?

Olubode A Olufajo; David Metcalfe; Arturo Rios-Diaz; Elizabeth Lilley; Joaquim M Havens; Edward Kelly; Joel S Weissman; Adil H Haider; Ali Salim; Zara Cooper

doi:10.1016/j.jamcollsurg.2016.02.002

Does Hospital Experience Rather than Volume Improve Outcomes in Geriatric Trauma Patients?

J Am Coll Surg. 2016 Jul;223(1):32-40.e1. doi: 10.1016/j.jamcollsurg.2016.02.002. Epub 2016 Feb 13.

Authors

Affiliations

¹ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: [email protected].
² Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
³ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
⁴ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
⁵ Center for Surgery and Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA.

PMID: 27055588
DOI: 10.1016/j.jamcollsurg.2016.02.002

Abstract

Background: Although high absolute hospital geriatric trauma volume (GTV) is associated with improved outcomes among geriatric trauma patients, the actual geriatric trauma proportion (GTP) might be a better predictor of outcomes.

Study design: Adult trauma admissions were identified in the California State Inpatient Database, 2007 to 2011. Hospital characteristics were extracted from the American Hospital Association database. The annual trauma volume of patients 65 years and older was calculated for each hospital. The GTP was derived by dividing the GTV by the overall adult trauma volume and hospitals were categorized into tertiles of GTP. Outcomes were hospital mortality, failure to rescue (FTR), and 30-day readmission in geriatric trauma patients. Independent risk factors were assessed with clustered multivariate logistic regression models adjusted for patient and hospital characteristics.

Results: There were 61,915 geriatric trauma patients included from 63 trauma centers. Hospital mortality, FTR, and 30-day readmission rates were 4.99%, 16.07%, and 12.03%, respectively. The adjusted odds ratios and 95% CIs for in-hospital mortality and FTR per 100 patient increase in GTV were 0.91 (95% CI, 0.83-1.00) and 1.01 (95% CI, 0.90-1.14), respectively. As compared with hospitals in the lowest tertile, adjusted odds of mortality and FTR in the highest tertile were 0.71 (95% CI, 0.54-0.94) and 0.67 (95% CI, 0.48-0.92), respectively. None of the hospital factors measured was significantly associated with readmission. The Wald test revealed that GTP played a larger role than GTV in predicting hospital mortality (p = 0.018 vs p = 0.048) and FTR (p = 0.015 vs p = 0.985).

Conclusions: Treatment at hospitals with higher GTP is associated with lower hospital mortality and FTR among geriatric patients. These findings suggest that creation of specialized services for geriatric trauma care can improve outcomes among geriatric trauma patients.

Publication types

Comparative Study

MeSH terms

Age Factors
Aged
Aged, 80 and over
California
Databases, Factual
Failure to Rescue, Health Care / statistics & numerical data
Female
Follow-Up Studies
Health Services for the Aged / statistics & numerical data*
Hospital Mortality
Hospitals, High-Volume / statistics & numerical data*
Hospitals, Low-Volume / statistics & numerical data*
Humans
Logistic Models
Male
Patient Readmission / statistics & numerical data
Risk Factors
Treatment Outcome
Wounds and Injuries / mortality
Wounds and Injuries / therapy*