title: Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study.
abstract: OBJECTIVE
  To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals.
  
  
  METHODS
  Population-based observational study.
  
  
  METHODS
  All acute hospitals in California, USA.
  
  
  METHODS
  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.
  
  
  METHODS
  Quality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Metcalfe
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Olubode
authors.initials: O
authors.lastname: Olufajo
authors.affiliation: Department of Epidemiology and Preventive Medicine, The Alfred Centre, Melbourne, Victoria, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Gabbe
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Zogg
authors.affiliation: Department of Trauma & Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: University of Liverpool, Liverpool, Merseyside, UK.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Perry
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000628:therapy*; D005269:Femur; D006615:Hip; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006760:Hospitalization; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011787:Quality of Health Care; D014481:United States
keywords: hip fracture; minimum volume standards; volume-outcome