医院老年创伤治疗经验影响长期生存率。
Hospital experience with geriatric trauma impacts long-term survival.
作者信息
Castillo-Angeles Manuel, Zogg Cheryl K, Jarman Molly P, Nitzschke Stephanie, Askari Reza, Cooper Zara, Salim Ali, Havens Joaquim M
机构信息
Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA.
出版信息
Am J Surg. 2025 Apr;242:116227. doi: 10.1016/j.amjsurg.2025.116227. Epub 2025 Jan 29.
BACKGROUND
Hospital experience measured by geriatric trauma proportion (GTP) is associated with in-hospital mortality among geriatric patients. Our goal was to determine the impact of GTP on long-term survival among older trauma patients.
METHODS
This was a retrospective analysis of Medicare inpatient claims (2014-2015) of geriatric trauma patients admitted in Florida. GTP was calculated by dividing the number of geriatric trauma patients by the overall adult trauma volume in each hospital. Hospitals were then categorized into tertiles of GTP. Our main outcome was mortality at 30, 90, 180, and 365 days. Multivariable regression was performed to identify the association between GTP and long-term survival.
RESULTS
We included 65,763 geriatric trauma patients. As compared with hospitals in the lowest tertile, patients treated at the highest tertile were associated with lower mortality at 90 days (OR 0.90, 95%CI 0.82-0.98), 180 days (OR 0.90, 95%CI 0.83-0.97), and 365 days (OR 0.91, 95%CI 0.85-0.98).
CONCLUSIONS
Higher GTP is associated with improved long-term outcomes. However, mortality following trauma among geriatric patients continues to increase for 12 months.
背景
以老年创伤比例（GTP）衡量的医院经验与老年患者的院内死亡率相关。我们的目标是确定GTP对老年创伤患者长期生存的影响。
方法
这是一项对佛罗里达州收治的老年创伤患者医疗保险住院索赔（2014 - 2015年）的回顾性分析。GTP通过将老年创伤患者数量除以每家医院的成年创伤患者总数来计算。然后将医院分为GTP三分位数组。我们的主要结局是30天、90天、180天和365天的死亡率。进行多变量回归以确定GTP与长期生存之间的关联。
结果
我们纳入了65763名老年创伤患者。与最低三分位数组的医院相比，最高三分位数组治疗的患者在90天（OR 0.90，95%CI 0.82 - 0.98）、180天（OR 0.90，95%CI 0.83 - 0.97）和365天（OR 0.91，95%CI 0.85 - 0.98）时的死亡率较低。
结论
较高的GTP与改善的长期结局相关。然而，老年患者创伤后的死亡率在12个月内持续上升。
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