Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgery
Published in: World Journal of Surgery 6/2008

01-06-2008

Regional Variation in Hospital Mortality and 30-day Mortality for Injured Medicare Patients

Authors: Adam S. Gorra, David E. Clark, Richard J. Mullins, Michael A. DeLorenzo

Published in: World Journal of Surgery | Issue 6/2008

Login to get access

Abstract

Background

We sought to evaluate how survival of older patients with injuries differs by geographic region within the United States.

Methods

We analyzed Medicare fee-for-service records for patients aged 65 years and older with principal injury diagnoses (ICD-9 800–959, excluding 905, 930–939, 958). Cases were classified by Maximum Abbreviated Injury Score (AISmax) and Charlson Comorbidity score (0, 1, 2, ≥3). Hospital mortality and 30-day mortality were modeled as functions of age, sex, AISmax, comorbidity, and geographic region (northeast, midwest, south, west).

Results

Hospital and 30-day mortality were both higher with male sex and increased age, AISmax, or Charlson score. Adjusted hospital mortality was highest in the northeast and south, but 30-day adjusted mortality was lowest in the same two regions.

Conclusions

Regional differences in risk-adjusted hospital survival for older patients with injuries are different from regional differences in 30-day survival. Hospital mortality as an outcome for older injured patients should be interpreted cautiously.
Literature
1.
Mullins RJ, Mann NC, Hedges JR, et al. (1998) Adequacy of hospital discharge status as a measure of outcome among injured patients. JAMA 279:1727–1731PubMedCrossRef
2.
Mullins RJ, Diggs BS, Hedges JR, et al. (2006) Regional differences in outcomes for hospitalized injured patients. J Trauma 60:691–700PubMedCrossRef
3.
MacKenzie EJ, Steinwachs DM, Shankar B (1989) Classifying trauma severity based on hospital discharge diagnoses. Validation of an ICD-9CM to AIS-85 conversion table. Med Care 27:412–422PubMedCrossRef
4.
(1971) Rating the severity of tissue damage. I. The abbreviated scale. JAMA 215:277–280
5.
Charlson ME, Pompei P, Ales KL, et al. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383PubMedCrossRef
6.
Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46:1075–1079PubMedCrossRef
7.
Morrill R, Cromartie J, Hart LG (1999) Metropolitan, urban, and rural commuting areas: Towards a better depiction of the U.S. settlement system. Urban Geog 20:727–748CrossRef
8.
Taylor DH Jr, Whellan DJ, Sloan FA (1999) Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries. N Engl J Med 340:293–299PubMedCrossRef
9.
Clark DE, DeLorenzo MA, Lucas FL, et al. (2007) Initial presentation of older injured patients to high-volume hospitals is not associated with lower 30-day mortality in Medicare data. Crit Care Med 35:1829–1836PubMedCrossRef
10.
Jencks SF, Williams DK, Kay TL (1988) Assessing hospital-associated deaths from discharge data. JAMA 260:2240–2246PubMedCrossRef
11.
Johnson ML, Gordon HS, Petersen NJ, et al. (2002) Effect of definition of mortality on hospital profiles. Med Care 40:7–16PubMedCrossRef
12.
Likosky DS, Nugent WC, Clough RA, et al. (2006) Comparison of three measurements of cardiac surgery mortality for the Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg 81:1393–1395PubMedCrossRef
13.
Carey JS, Parker JP, Robertson JM, et al. (2003) Hospital discharge to other healthcare facilities: Impact on in-hospital mortality. J Am Coll Surg 197:806–812PubMedCrossRef
14.
Clark DE, DeLorenzo MA, Lucas FL, et al. (2004) Epidemiology and short-term outcomes of injured Medicare patients. J Am Geriatr Soc 52:2023–2030PubMedCrossRef
Metadata
Title
Regional Variation in Hospital Mortality and 30-day Mortality for Injured Medicare Patients
Authors
Adam S. Gorra
David E. Clark
Richard J. Mullins
Michael A. DeLorenzo
Publication date
01-06-2008
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 6/2008
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-007-9410-y

Other articles of this Issue 6/2008

World Journal of Surgery 6/2008 Go to the issue

OriginalPaper

Applying Modern Error Theory to the Problem of Missed Injuries in Trauma

Invited Commentary

What is a Surgical Complication?

OriginalPaper

What is a Surgical Complication?

OriginalPaper

Risk Factors and Clinical Outcome for Anastomotic Leakage After Total Mesorectal Excision for Rectal Cancer

Invited Commentary

What Is a Surgical Complication?

Erratum

Thoracoscopic Cervicothoracic Sympathectomy for Treatment of Upper Extremity Ischemia