Abstract
Introduction
Prior analysis demonstrates improved survival for older trauma patients (age > 64 years) treated at trauma centres that manage a higher proportion of geriatric patients.
We hypothesised that ‘failure to rescue’ (death after a complication during an in-hospital
stay) may be responsible for part of this variation. The objective of the study was
to determine if trauma centre failure to rescue rates are associated with the proportion
of older trauma seen.
Methods
We analysed data from high volume level 1 and 2 trauma centres participating in the
National Trauma Data Bank, years 2007–2011. Centres were categorised by the proportion
of older trauma patients seen. Logistic regression analyses were used to provide risk-adjusted
rates for major complications (MC) and, separately, for mortality following a MC.
Models were adjusted for patient demographics, comorbid conditions, mechanism and
type of injury, presenting vital signs, injury severity, and multiple facility-level
covariates. Risk-adjusted rates were plotted against the proportion of older trauma
seen and trends determined.
Results
Of the 396,449 older patients at 293 trauma centres that met inclusion criteria, 30,761
(8%) suffered a MC. No difference was found in the risk-adjusted incidence of MC by
proportion of older trauma seen. A MC was associated with 34% of all deaths. Of those
that suffered a MC, 7413 (24%) died and 76% were successfully rescued. Centres treating
higher proportions of older trauma were more successful at rescuing patients after
a MC occurred. Patients seen at centres that treat >50% older trauma were 33% (OR = 0.67, 95% CI 0.47–0.96) less likely to die following a MC than in centres treating
a low proportion (10%) of older trauma.
Conclusions
Centres more experienced at managing geriatric trauma are more successful at rescuing
older patients with serious complications. Processes of care at these centres need
to be further examined and used to inform appropriate interventions.
Keywords
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References
United States Census Bereau. State & Country Quick Facts. Available from http://quickfacts.census.gov/qfd/states/00000.html; [accessed 02.02.15].
- Injury Prevention & Control: Data & Statistics (WISQARSTM).2015 (Available from http://www.cdc.gov/injury/wisqars/; [accessed 02.02])
- Acute hospital costs of trauma in the United States: implications for regionalized systems of care.J Trauma. 1990; 30 (discussion 101–3): 1096-1101
- Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.J Trauma. 1998; 45: 805-810
- Trauma in the elderly: intensive care unit resource use and outcome.J Trauma. 2002; 53: 407-414
- Outcomes of older trauma care at centers treating a higher proportion of older patients.J Trauma Acute Care Surg. 2015; 78: 852-978
- Variation in hospital mortality associated with inpatient surgery.N Engl J Med. 2009; 361: 1368-1375
- Adaptation of AHRQ patient safety indicators for use in ICD-10 administrative data by an international consortium.in: Advances in patient safety: new directions and alternative approaches (assessment) advances in patient safety. vol. 1. Agency for Healthcare Research and Quality, Rockville, MD, USA2008
- Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients.Ann Surg. 2009; 250: 1029-1034
- Prevention of complications and successful rescue of patients with serious complications: characteristics of high-performing trauma centers.J Trauma. 2011; 70: 575-582
- Positive and negative volume-outcome relationships in the geriatric trauma population.JAMA Surg. 2014;
- Outcomes after emergency general surgery at teaching versus nonteaching hospitals.J Trauma Acute Care Surg. 2015; 78: 69-77
American College of Surgeons. National Truama Data Bank (NTDB). Available from: https://www.facs.org/quality%20programs/trauma/ntdb.
- The attributable mortality and length of stay of trauma-related complications: a matched cohort study.Ann Surg. 2010; 252: 358-362
- Developing best practices to study trauma outcomes in large data bases: an evidence based approach to determine the best mortality risk adjustment model.J Trauma. 2014; 76: 1061-1069
- Impact of statistical approaches for handling missing data on trauma center quality.Ann Surg. 2009; 249: 143-148
- Multiple imputation in trauma disparity research.J Surg Res. 2011; 165 (e37-41)
- Rethinking priorities: cost of complications after elective colectomy.Ann Surg. 2015; ([Epub ahead of print])
- Hospital and patient characteristics associated with death after surgery. A study of adverse occurrence and failure to rescue.Med Care. 1992; 30: 615-629
- Failure-to-rescue: comparing definitions to measure quality of care.Med Care. 2007; 45: 918-925
- Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.JAMA: J Am Med Assoc. 2002; 288: 1987-1993
- Hospital nurse practice environments and outcomes for surgical oncology patients.Health Serv Res. 2008; 43: 1145-1163
- Hospital volume and failure to rescue with high-risk surgery.Med Care. 2011; 49: 1076-1081
- Variation in hospital complication rates and failure-to-rescue for trauma patients.Ann Surg. 2011; 253: 811-816
- Getting under the hood of the volume-outcome relationship for radical cystectomy.J Urol. 2007; 177 (discussion): 2095-2099
- The evolution of trauma surgery at a high-volume Canadian centre: implications for public health, prevention, clinical care, education and recruitment.Can J Surg J Can Chir. 2015; 58: 19-23
- A national evaluation of the effect of trauma-center care on mortality.N Engl J Med. 2006; 354: 366-378
- Geriatric outcomes are improved by a geriatric trauma consultation service.J Trauma. 2006; 61: 1040-1046
- The effect of pre-existing medical conditions and age on mortality after injury.J Trauma. 2006; 61: 1255-1260
- When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma.J Trauma. 2002; 52: 242-246
- Preexisting conditions and mortality in older trauma patients.J Trauma. 2004; 56: 1291-1296
- Variations in postoperative complications according to race, ethnicity, and sex in older adults.J Am Geriatr Soc. 2013; 61: 1499-1507
- Minimizing perioperative adverse events in the elderly.Br J Anaesth. 2001; 87: 608-624
Article info
Publication history
Published online: December 16, 2015
Accepted:
November 25,
2015
Identification
Copyright
© 2016 Published by Elsevier Ltd.
