Femoral Fractures: Which is better? High-Volume or Low-Volume Hospital
Rehabilitation outcomes are one category of outcomes. Health care considers big picture outcomes also - especially when it comes to surgical procedures.
It appears that if a 65+ year old acquires a femoral fracture, it's okay if the surgical repair is not immediate due to having to wait for the surgical procedure. Low-volume hospitals have about a 2 day longer wait for the repair to happen. Although this seems like it could increase the risk for things like death, 30-day re-admission, pneumonia, embolism or ulcers, it really doesn't.
Here's a quick view of the abstract.
Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study.
To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals.
Population-based observational study.
All acute hospitals in California, USA.
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).
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.
These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.