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 Seniors with hip fractures waited longer for surgery and were more
likely to be rehospitalized if they were treated at a major trauma
center than if they went to a smaller emergency room, researchers
found.
Seniors in so-called level 1 trauma centers were also more likely to
develop blood clots in their legs, compared to their peers who were
treated in settings designed for less serious injuries, the
researchers write in Medical Care.
Level 1 trauma centers have the resources to treat very serious
injuries, said lead author Dr. David Metcalfe of Brigham and Women’s
Hospital in Boston.
“However, because they care for the most complex patients, these
hospitals are often very busy. There is therefore a risk that some
groups of patients might be disadvantaged or ‘lost’ in the system,”
Metcalfe told Reuters Health by email.
For example, patients with multiple injuries or bones breaking
through skin may be treated before seniors with hip fractures.
Each year in the U.S. alone, more than 250,000 people aged 65 and
older are hospitalized for hip fractures, according to the Centers
for Disease Control and Prevention.
The study team used statewide data from California on 91,401 seniors
hospitalized between 2007 and 2011. All were over age 65 and had
surgery for hip fractures.
Overall, six percent were treated at a level 1 trauma center, 18
percent at a level 2 trauma center (where very seriously injured
patients can be stabilized), and 70 percent in a non-trauma center.
On average, patients stayed in the hospital for five days and waited
one day for surgery.
Patients in level 1 trauma centers stayed for one day longer than
those in the other settings and waited nearly eight hours longer for
surgery.
Seniors treated at level 1 centers were 62 percent more likely to be
readmitted to the hospital within a month of their surgery than
seniors treated in level 2 or non-trauma settings.
Seniors were also 32 percent more likely to develop blood clots in
their legs at level 1 centers.
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Patients at level 2 trauma centers had the same outcomes as those at
non-trauma centers, the authors found.
There was no difference between any of the groups in risk of death,
bed sores, or pneumonia, however.
“We now know that it is important to treat patients with hip
fractures as quickly as possible,” said Metcalfe, noting that older
adults who wait too long for treatment may be at risk for bed sores,
blood clots, and lung infections.
“The concern is that this delay will lead to increasing length of
stay in hospital as well as increased complications for the patients
because they spend longer in bed waiting for surgery,” said Dr.
Chris Gooding, a surgeon at Addenbrookes Hospital, a level 1 trauma
center in Cambridge, UK. Gooding was not involved in the study.
“This is an important subject as in developed countries we have an
aging population and as a result we are seeing increasing numbers of
patients with hip fractures,” Gooding told Reuters Health by email.
At the same time, Gooding noted, there are also a growing number of
level 1 trauma centers.
“One of the best ways to help these patients is to get their
operation done quickly so that they can start walking again and
return to their own homes as soon as possible,” Metcalfe advised.
SOURCE: bit.ly/1PHZ2ys Medical Care, online March 11, 2016.
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