Department of Surgery, 23703Ocala Regional Medical Center, Ocala, FL, USA.
University of Central Florida, Ocala, FL, USA.
Am Surg. 2022 Apr;88(4):587-596. doi: 10.1177/00031348211056284. Epub 2021 Nov 11.
Patient safety indicators (PSIs) are avoidable complications that can impact outcomes. Geriatric patients have a higher mortality than younger patients with similar injuries, and understanding the etiology may help reduce mortality. We aim to estimate preventable geriatric trauma mortality in the United States and identify PSIs associated with increased preventable mortality.
A retrospective cohort study of patients aged ≥65 years, in the CMS database, 2017-second quarter of 2020. Risk-adjusted multivariable regression was performed to calculate observed-to-expected (O/E) mortality ratios for failure-to-prevent and failure-to-rescue PSIs with significance defined as < .05.
3 452 339 geriatric patients were analyzed. Patients aged 75-84 years had 33% higher odds of preventable mortality (adjusted odds ratio [aOR] = 1.33 and 95% confidence interval [CI] = 1.31, 1.36), whereas patients aged ≥85 years had 91% higher odds of preventable mortality (aOR = 1.91 and 95% CI = 1.87, 1.94) compared to patients aged 65-74 years. Failure-to-prevent O/E were >1 for all PSIs evaluated with central line-related blood stream infection having a high O/E (747.93). Failure-to-rescue O/E were >1 for 10/11 (91%) PSIs with physiologic and metabolic derangements having the highest O/E (5.98). United States' states with higher quantities of geriatric trauma patients experienced reduced preventable mortality.
Odds of preventable mortality increases with age. Perioperative venous thrombotic events, hemorrhage or hematoma, and postoperative physiologic/metabolic derangements produce significant preventable mortalities. United States' states differ in their failure-to-prevent and failure-to-rescue PSIs. Utilization of national guidelines, minimization of central venous catheter use, addressing polypharmacy especially anticoagulation, ensuring operative and procedure-based competencies, and greater incorporation of inpatient geriatricians may serve to reduce preventable mortality in elderly trauma patients.
患者安全指标（PSIs）是可避免的并发症，可能会影响预后。老年患者的死亡率高于同年龄段、具有相似损伤的年轻患者，了解病因可能有助于降低死亡率。我们旨在估计美国可预防的老年创伤死亡率，并确定与可预防死亡率增加相关的 PSIs。
这是一项在 CMS 数据库中对 2017 年第二季度至 2020 年期间年龄≥65 岁患者进行的回顾性队列研究。采用风险调整多变量回归计算预防失败和救援失败 PSIs 的观察到的预期（O/E）死亡率比值，显著性定义为 <.05。
共分析了 3452339 名老年患者。75-84 岁的患者发生可预防死亡率的可能性增加 33%（调整后的优势比[aOR]为 1.33，95%置信区间[CI]为 1.31，1.36），而≥85 岁的患者发生可预防死亡率的可能性增加 91%（aOR 为 1.91，95%CI 为 1.87，1.94）与 65-74 岁的患者相比。所有评估的 PSIs 的预防失败 O/E 均>1，其中中心静脉置管相关血流感染的 O/E 最高（747.93）。11 项（91%）PSIs 的救援失败 O/E>1，其中生理和代谢紊乱的 O/E 最高（5.98）。美国老年创伤患者数量较多的州经历了可预防死亡率的降低。
可预防死亡率随年龄增长而增加。围手术期静脉血栓栓塞事件、出血或血肿以及术后生理/代谢紊乱会导致显著的可预防死亡。美国各州在预防失败和救援失败 PSIs 方面存在差异。利用国家指南、尽量减少中心静脉导管的使用、解决药物滥用尤其是抗凝治疗、确保手术和操作能力以及更大程度地纳入住院老年病专家可能有助于降低老年创伤患者的可预防死亡率。
