C. M. Psoinos1, J. M. Flahive1, F. Anderson1, H. P. Santry1 1University Of Massachusetts Medical School,Surgery,Worcester, MA, USA
Introduction: Survival to discharge is increasingly considered a poor measure of post-injury outcome. We studied post-discharge mortality in a national sample of elderly trauma patients.
Methods: A 5% random sample of Medicare Beneficiaries (n=864,604) was queried for patients admitted (1/1/2009-12/31/2010) with a primary diagnosis code (ICD9) for traumatic injury. We examined inpatient and post-discharge mortality until 12/31/2011 using univariate tests of association and multivariable logistic regression models to determine predictors (demographic factors, Elixhauser co-morbidity index, critical injury) of EARLY post-discharge (0-30 days) and LATE (31-365 days) mortality. Critical injury was defined as intensive care unit (ICU) stay ≥1 day and an abbreviated injury score (AIS) in any one region ≥3.
Results: Of 60,016 elderly trauma patients, 1,832 died during index hospitalization (3.1%). Age, sex, Elixhauser index, and critical injury (all p≤0.01) were independent predictors of inpatient mortality.
Of the 58,184 patients discharged alive, 2,318 (4.9%) died EARLY and 9,123(15%) died LATE. Figure 1 shows unadjusted rates of EARLY and LATE mortality for factors associated with mortality in univariate analyses. In multivariable models, age ≥85, male sex, Elixhauser index ≥3 critical injury and discharge disposition (all p≤0.01) were independent predictors of EARLY mortality. Age, sex, Elixhauser index, and discharge disposition (all p≤0.01) predicted LATE mortality. For the EARLY model, significant discharge locations for increased odds of mortality (referent group discharge home) were home with services (OR 1.9, 95%CI 1.6, 2.2), LTAC (OR 11, 95%CI 8.8, 14), and rehabilitation facility (OR 2.4, 95%CI 1.9, 2.9). Discharge dispositions predictive of LATE mortality were home with services (OR 1.6, 95%CI 1.5, 1.7), LTAC (OR 5.0, 95% CI 4.2, 6.0), other in-patient (OR 2.1, 95%CI 1.9, 2.4), and rehabilitation facility (OR 1.5, 95%CI 1.4, 1.7).
Conclusion: Nearly a quarter of elderly trauma patients were dead by 1 year after injury, with deaths during index hospitalization accounting for ~3% of this mortality. The association between age, sex, comorbidities, severity of injury & condition at discharge and post-discharge mortality suggests that, baseline patient condition, factors leading up to injury and physiologic & functional consequences of injury all play a role in long-term mortality. While further research is needed, our findings have implications for framing expectations for post-discharge outcomes after injury in the elderly.
