Study Examines Outcomes, Volume of Geriatric Trauma Cases

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 study by Kazuhide Matsushima, M.D., of the University of Southern California, and colleagues.

The association between higher hospital volume and lower mortality rates in complex surgical procedures has been well documented, according to the study background.

In this study, researchers 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.

Between 2001 and 2010, 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.

Odds of in-hospital death, major complications (such as respiratory failure, kidney failure and heart attack), 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 results.

“These results should help focus the discussion about how to allocate geriatric trauma patients to appropriate receiving centers,” the authors conclude.

(JAMA Surgery. Published online January 22, 2014. doi:10.1001/jamasurg.2013.4834.