Hospital case volume and outcomes for proximal femoral fractures in the USA: an observational study

OBJECTIVE: To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals. DESIGN: Population-based observational study. SETTING: All acute hospitals in California, USA. PARTICIPANTS: 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. PRIMARY AND SECONDARY OUTCOMES: 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.