FOTO Rehab Outcomes Blog

Femoral Fractures: Which is better? High-Volume or Low-Volume Hospital

Written by Selena Horner | Jan 9, 2017 11:00:00 AM

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.


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.

BMJ Open. 2016 Apr 7;6(4):e010743. doi: 10.1136/bmjopen-2015-010743.