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To explore whether older adults with isolated hip fractures benefit from treatment in high-volume hospitals.Population-based observational study.All acute hospitals in California, USA.All individuals aged ≥65 that underwent an operation for an isolated hip fracture in California between 2007 and 2011. Patients transferred between hospitals were excluded.Quality indicators (time to surgery) and patient outcomes (length of stay, in-hospital mortality, unplanned 30-day readmission, and selected complications).91,401 individuals satisfied the inclusion criteria. Time to operation and length of stay were significantly prolonged in low-volume hospitals, by 1.96 (95% CI 1.20 to 2.73) and 0.70 (0.38 to 1.03) days, respectively. However, there were no differences in clinical outcomes, including in-hospital mortality, 30-day re-admission, and rates of pneumonia, pressure ulcers, and venous thromboembolism.These data suggest that there is no patient safety imperative to limit hip fracture care to high-volume hospitals.

Original publication




Journal article


BMJ open

Publication Date





Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, USA Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, UK.


Hip, Femur, Humans, Femoral Fractures, Hip Fractures, Hospitalization, Length of Stay, Patient Readmission, Hospital Mortality, Aged, Aged, 80 and over, Quality of Health Care, Outcome Assessment (Health Care), United States, California, Female, Male, Hospitals, High-Volume, Hospitals, Low-Volume