Effect of institution volume on mortality and outcomes in osteoporotic hip fracture care

Shabani, Farzad; Tsinaslanidis, Georigs; Thimmaiah, Ravindra; Khatak, Mohammad; Shenoy, Pritom M; Offorha, Bright C.; Onafowokan, O. O.; Uzoigwe, Chika Edward; Oragui, Emeka; Smith, Robert P.; Middleton, Rory G; Johnson, Nick R.

doi:10.1007/s00198-021-06249-y

Cited by 1 publication

(3 citation statements)

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“…The probability of receiving orthogeriatric co-treatment increased with higher volumes, up to 367 patients per year. This is in line with the study by Shabani et al, who also found that higher-volume hospitals scored better on several preoperative medical assessments [ 9 ]. It is plausible that these hospitals are more likely dedicated hip fracture centers, with an orthogeriatric ward or a dedicated hip fracture team allowing co-treatment by a geriatrician.…”

Section: Discussionsupporting

confidence: 92%

“…For time in the ED, the polynomial spline fluctuated, especially for lower volumes with a wider confidence interval, but did not show a trend toward increasing or decreasing turnaround times with the increase of volume. For surgery within 48 h, the modeled probability changed only by 3% (between 91 and 94%).The effect of hospital volume on turnaround times in the ED was only studied earlier by Shabani et al, who did not find an effect of volume on time to admission to an orthopedic ward, nor on the HLOS [ 9 ]. The latter finding corresponds with our study in which HLOS was not associated with hospital volume.…”

Section: Discussionmentioning

confidence: 99%

“…Almost 90 percent of the studies published on the hospital volume–outcome relationship in orthopedic surgery found a positive effect of higher hospital volumes on outcomes [ 8 ]. However, evidence for the relationship between hospital volume and outcomes of hip fracture surgery is inconclusive [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Is hospital volume related to quality of hip fracture care? Analysis of 43,538 patients and 68 hospitals from the Dutch Hip Fracture Audit

Würdemann

Zwet²,

Krijnen³

et al. 2023

Eur J Trauma Emerg Surg

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Purpose Evidence for a hospital volume–outcome relationship in hip fracture surgery is inconclusive. This study aimed to analyze the association between hospital volume as a continuous parameter and several processes and outcomes of hip fracture care. Methods Adult patients registered in the nationwide Dutch Hip Fracture Audit (DHFA) between 2018 and 2020 were included. The association between annual hospital volume and turnaround times (time on the emergency ward, surgery < 48 h and length of stay), orthogeriatric co-treatment and case-mix adjusted in-hospital and 30 days mortality was evaluated with generalized linear mixed models with random effects for hospital and treatment year. We used a fifth-degree polynomial to allow for nonlinear effects of hospital volume. P-values were adjusted for multiple comparisons using the Bonferoni method. Results In total, 43,258 patients from 68 hospitals were included. The median annual hospital volume was 202 patients [range 1–546]. Baseline characteristics did not differ with hospital volume. Provision of orthogeriatric co-treatment improved with higher volumes but decreased at > 367 patients per year (p < 0.01). Hospital volume was not significantly associated with mortality outcomes. No evident clinical relation between hospital volume and turnaround times was found. Conclusion This is the first study analyzing the effect of hospital volume on hip fracture care, treating volume as a continuous parameter. Mortality and turnaround times showed no clinically relevant association with hospital volume. The provision of orthogeriatric co-treatment, however, increased with increasing volumes up to 367 patients per year, but decreased above this threshold. Future research on the effect of volume on complications and functional outcomes is indicated.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%