In Hospital Hip Fracture Mortality Colleen McLaughlin, MPH, PhD Division of Quality and Patient Safety

Background STAC request to examine in hospital mortality among hip fracture patients – Is trauma center status associated with risk of in hospital death – Are higher risk patients more likely to be treated at trauma centers – What are the trends in hip fracture inpatient mortality

Methods AHRQ Inpatient Quality Indicator IQI19 Hip Fracture Mortality National Quality Forum (NQF) Endorsed Measure (NQF #354) Risk adjusted using All Patient Refined DRG and Risk of Mortality (APR-DRG- ROM) – ROM is based on comorbidities

IQI19 Hip fracture mortality definition Denominator: All discharges, age 65 years and older, with principal diagnosis code for hip fracture (risk set) – Excludes patients with any diagnosis of periprosthetic fracture or who were transferred to another short-term hospital Numerator: In hospital deaths among risk set

Risk adjustment coefficients (national data) APR-DRG risk of mortality 1=minor 2=moderate 3=major 4=extreme

Sample Risk of Mortality Minor: 84 yrs old – Pertrochanteric fracture, closed, Intertrochanteric section; & other wounds – Sinusitis; hypertension; degenerative disc disease Extreme: 94 yr old – Same fracture – Acute renal failure; Pulmonary collapse; Congestive heart failure; other comorbidities

New York Data SPARCS inpatient discharge data – Stratified analysis by trauma center, large ED (100+ visits per day), and all other facilities by facility – Risk factors for mortality based on NY data

Statewide Observed Hip Fracture Mortality,

Hip Fracture Mortality by ED Type, NYS, 2011 Statewide rate

Hip Fracture Mortality by ED Type, NYS, 2010 Statewide rate

Hip Fracture Mortality by ED type, 2011

Hip Fracture Mortality by ED type, 2010

Odds ratios for in hospital death among hip fracture patients, NYS, 2011 patientsdeaths case fatality (%)OR 95% Confidence Intervals Age (yrs) (reference) Gender Male (reference) Female Type of ED Trauma center (reference) Large ED Other facilities

Odds ratios for in hospital death among hip fracture patients, NYS, 2011 patientsdeaths case fatality (%)OR 95% Confidence Intervals femur fracture femur fracture femur fracture femur fracture hip replacement 1/ hip replacement hip replacement hip surgery/trauma (reference) hip surgery/trauma hip surgery/trauma hip surgery/trauma other dx other dx other dx

Does being treated at a trauma center improve the outcomes for patients with high Risk of Mortality? OR contrasting all other facilities to trauma centers, NYS 2011 ROMOR95% CI minor moderate major extreme OR contrasting all other facilities to trauma centers, NYS 2010 ROMOR95% CI minor moderate major extreme

Percent of Patients seen at Trauma Centers by Risk Adjustment Variables APR-DRG ROM 1=minor 2=moderate 3=major 4=extreme

Conclusion Treatment in a trauma center is generally not associated with statistically significantly improved in hospital mortality risk Other than those with multiple significant trauma, hip fracture patients are not more likely to be treated in a trauma center compared to patients with other conditions