Geriatric Trauma, Frailty, and American College of Surgeons Trauma Center Verification Level: Are There Any Correlations with Outcomes?

Abstract

INTRODUCTION: Frailty is prevalent among the elderly and confers increased risk for adverse outcomes. We aimed to assess the effect of American College of Surgeons (ACS) trauma center verification level on outcomes among frail and nonfrail geriatric trauma patients. METHODS: We analyzed the 2017 to 2019 ACS-TQIP including geriatric (65 years or older) trauma patients who presented to ACS Level I, II, or III trauma centers. Patients who were transferred or had missing data on verification level and hospital discharge disposition were excluded. Modified frailty index was calculated. After stratification into frail and nonfrail, matching was performed. Outcomes were adverse discharge (rehabilitation/SNF) and mortality. RESULTS: We identified 286,054 patients, and 110,680 patients were matched (frail: 55,340; nonfrail: 55,340). Of these, 2.8% died, and 55% had adverse discharge. Geriatric patients had lower rates of adverse discharge in Level I and II centers compared with Level III centers (52.6%, 55.8%, 60.9%, p < 0.001) regardless of frailty and injury severity, and higher rates of mortality in Level I and II centers compared with Level III trauma centers (4.9%, 3.7%, 2.8%, p < 0.001) among the moderate-to-severely injured only. Frail patients were more likely to die and be discharged to rehabilitation/SNF (Table).ACS, American College of Surgeons; ISS, Injury Severity Score.CONCLUSION: Mortality is low regardless of injury severity for geriatric trauma patients managed at ACS trauma centers. More than half of geriatric trauma patients are discharged to rehabilitation/SNF. Higher-level centers have higher mortality but lower rates of adverse discharge, regardless of frailty status and injury severity, and Level III centers may be underperforming with regards to resource allocation. Higher-level centers may be prioritizing quality of life over survival. Further studies are required to explore the relationship between frailty, verification level, end-of-life decision making, and transfer practices.