# Delays and Discrepancies in the Care of Older Injured Patients Across the United Kingdom: A Cohort Study

## TL;DR

Older injured patients in the UK face longer waits and more cancellations for surgery compared to younger patients, highlighting the need for improved care pathways.

## Contribution

The study provides the first comprehensive analysis of care delays and discrepancies for older trauma patients across the UK using a large database.

## Key findings

- Older adults make up 66% of trauma operations, with fragility proximal femur fractures being more common in this group.
- Older patients wait 40% longer as inpatients and 60% longer as outpatients for surgery compared to younger patients.
- They experience 25% more cancellations and are less likely to be escalated to elective surgery lists.

## Abstract

Introduction

The average age of patients undergoing orthopaedic trauma surgery increases with over half of these procedures performed on older patients (over 60 years old). Despite this, the treatment of older trauma patients varies widely from their younger counterparts. Whilst diverging demographics and differing management are previously reported, no data is available regarding injury characteristics, comparative delays, cancellations or escalation to other lists. Through an analysis of the ORTHOPOD database, we provide a unique insight to improve understanding and challenge the current status of anecdotes and dogma.

Methods

A total of 22,585 patients from 83 hospitals (61 trauma units (TUs) and 22 major trauma centres (MTCs)) across the United Kingdom (UK) admitted over two months (August 22, 2022, to October 16, 2022) were analyzed to determine contemporary care in older patients within the current pathways.

Results

Older adults dominate the trauma caseload with 66% of operations being performed on this cohort and fragility proximal femur fracture (FPFF) patients alone accounting for over 1,500 more operations than for all fractures in younger adults (6369 vs 4806). Older trauma patients wait 40% and 60% longer for surgery as inpatients and outpatients, respectively. They also experience 25% more cancellations and are more likely to be managed entirely within a TU, be treated as an inpatient and sustain lower limb fractures. Conversely, they are one-third less likely to be escalated to elective lists. Regarding FPFF patients specifically, 70% are treated in TUs but, if treated in an MTC, both the cancellation rate and inpatient surgical delay are 25% higher than in TUs.

Conclusion

This analysis demonstrates the inequity in treatment received by older trauma patients. Despite comprising most of the UK’s trauma burden, this cohort waits significantly longer for surgery as both inpatients and outpatients and experience higher cancellation rates. This is despite these patients being frailer and more likely to be treated as inpatients since their injuries are often severe, for example, all femoral fractures are more common in older adults. Furthermore, they are less likely to be escalated to elective lists. This corroborates the need for initiatives to integrate dedicated patient pathways for older injured patients within trauma networks, for example, older injured adult trauma multi-disciplinary teams.