A. V. Jambhekar1, R. Lindborg1, V. Chan1, B. Fahoum1, J. Rucinski1 1New York Methodist Hospital,Brooklyn, NY, USA
Introduction:
Hip fractures often result from low energy mechanisms of injury and seldom present with other traumatic injuries. One large retrospective cohort study has recently shown that patients with isolated hip fractures may not necessitate care at higher level trauma centers. The objective of this study was to determine if hip fracture patients have improved hospitalization outcomes since designation of the study hospital as a level II trauma center.
Methods:
Data was collected on 375 patients with hip fractures evaluated between April 1, 2014 and February 20, 2016. Patients were included if they presented to the Emergency Department with a traumatic mechanism of injury which manifested with a hip fracture. Patients less than 15 years of age were excluded from the study. Data was retrospectively collected using ICD 9 codes for the pre designation group from April 1, 2014 to March 30, 2015 (n = 234). Data was prospectively collected for the post designation group, or patients evaluated after the study hospital was designated as a level II trauma center on April 1, 2015 (n = 141). Analysis was conducted using the unpaired student’s T tests and chi square test.
Results:
Patients in the pre and post designation groups were of similar age (77.19 +/- 9.90 vs. 80.10 +/- 13.49; p = 0.076). Complication and mortality rates also remained similar between the two groups (8.1% vs. 8.5%; p = 0.89; 4.7% vs. 4.3%; p = 0.84). Length of stay was significantly shorter in the post designation group (20.23 +/- 2.60 vs. 6.52 +/- 1.10; p <0.0001). More patients were discharged to subacute rehabilitation facilities and fewer patients were discharged directly home in the post designation group (50% vs. 63.8%; p = 0.009; 9.8% vs. 2.1%; p = 0.004).
Conclusion:
Hip fracture management is multidisciplinary and requires optimizing systems of care. Trauma center designation at the study hospital appears to lead to a decreased length of inpatient hospitalization with an increased percentage of patients being discharged to skilled rehabilitation facilities. Management of patients with hip fractures at a designated higher level trauma center may lead to improved hospitalization outcomes and more cost effective care.