Does it matter where hip fractures are treated? Comparison between pre- and post- American college of surgeons trauma center verification process

Introduction: The American College of Surgeons-verified trauma center have been shown to have better outcomes as compared to non-trauma centers. The study aimed to investigate the impact of becoming an ACS-verified trauma center on patient outcomes for hip fractures regardless of admitting service.

Material & Methods: Retrospective review of our trauma registry (1/1/2007-12/31/2019) for patients with hip fracture. A hip fracture was defined as IT fractures sustained after a ground level fall (GFL). Demographics, admission service: medicine (Fragility Fracture Service), orthopedics, and trauma, Hospital-LOS, ICU-LOS, and disposition were analyzed. The patient populations are matched: age, ethnicity, and gender. An additive binomial regression model was used to compare the net change mortality between the three services. Results were expressed as net change with 95% confidence intervals. Poisson regression models were used to compare H-LOS, ICU-LOS, and days to OR between pre and post ACS-verification.

Results: Two thousand and eighty-one patients with hip fractures were admitted to our hospital between 2007-2019. Of those patients, 1045 were in the pre-certification period (2007-2015) and 1036 were in the post certification period (2016-2019). There is a decline in H-LOS, but no change in ICU-LOS or days to OR time amongst all three services. Trauma surgical service H-LOS declined from 8 days to 6 days (p-value<0.0001) and an ICU-LOS declined from 5 to 3.5 days (p<0.0001). The orthopedics H-LOS declined from 6 to 5 days (p<0.001) and there was no change in the ICU-LOS (p<0.064). For the FFS service the H-LOS decreased from 7 days to 5 days (p<0.0001) and an increase in ICU-LOS from 2 days to 4 days (p<0.001).

Conclusions: Achieving ACS verification had a positive impact on patient outcomes for hip fractures. An aging population and the increased likelihood of GLF, identifying systems thatprovide optimal outcomes like the ACS-verified trauma center is essential.

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