Hospital case volume and outcomes for proximal femoral fractures in the USA: An observational study

David Metcalfe, Ali Salim, Olubode Olufajo, Belinda Gabbe, Cheryl Zogg, Mitchel B. Harris, Daniel C. Perry, Matthew L. Costa

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25 Citations (Scopus)


Objective: To explore whether older adults with isolated hip fractures benefit from treatment in highvolume hospitals. 

Design: Population-based observational study. Setting: All acute hospitals in California, USA. 

Participants: All 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 outcomes: Quality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications). 

Results: 91 401 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. 

Conclusions: These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.

Original languageEnglish
Article numbere010743
Pages (from-to)1 - 7
Number of pages7
JournalBMJ Open
Issue number4
Publication statusPublished - 2016

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