Older trauma patients were less likely to die or have a major complication at hospitals with high volumes of geriatric trauma patients, and the chance of major complications increased for geriatric patients in hospitals with high volumes of younger patients, according to a one-state study.
The association between higher hospital volume and lower mortality rates in complex surgical procedures has been well-documented, according to the background information for the study, which was published Jan. 22 on the website of JAMA Surgery.
Kazuhide Matsushima, MD, of the University of Southern California, and colleagues used a statewide registry of trauma centers in Pennsylvania to examine differences in trauma care outcomes for geriatric patients based on how many geriatric and nongeriatric trauma patients were cared for at the hospitals.
There were 39,431 geriatric trauma patients and 105,046 younger patients in a review of outcomes at 20 level 1 and 2 trauma centers between 2001 and 2010.
Odds of in-hospital death, major complications (such as respiratory failure, kidney failure and myocardial infarction) and failure to rescue (death after a surgical complication) were lower in hospitals with higher volumes of geriatric trauma patients. Larger volumes of nongeriatric patients at hospitals were associated with higher odds of major complications in geriatric patients, according to the data.
These observations suggest that an institutions interventions to improve outcomes among its trauma patients may need to consider the needs of specific subgroups such as the elderly, the authors wrote.
In addition, they underscore the value of analysis such as that reported here, demonstrating that it is possible to detect the influence of care for one group of patients on the care of another group of patients especially in resource-limited settings.
Study abstract: http://archsurg.jamanetwork.com/article.aspx?articleid=1815006