Age itself or age-associated comorbidities? A nationwide analysis of outcomes of geriatric trauma

Fu, Chih-Yuan; Bajani, Francesco; Bokhari, Marissa; Starr, Frederick; Messer, Thomas; Kaminsky, Matthew; Dennis, Andrew; Schlanser, Victoria; Mis, Justin; Poulakidas, Stathis; Bokhari, Faran

PURPOSE: Geriatric trauma patients present physiological challenges to care providers. A nationwide analysis was performed to evaluate the roles of age alone versus age-associated comorbidities in the morbidity and mortality of elderly patients with blunt abdominal trauma (BAT). METHODS: Patients with BAT registered in the National Trauma Data Bank from 2013 to 2015 were analyzed using propensity score matching (PSM) to evaluate the mortality rate, complication rate, hospital length of stay (LOS), intensive care unit (ICU) LOS and ventilator days between young (age < 65) and elderly (age ≥ 65) patients. An adjusted multivariate logistic regression (MLR) model was also used to evaluate the effect of age itself and age-associated comorbidities on mortality. RESULTS: There were 41,880 patients with BAT during the study period. In elderly patients, the injury severity score (ISS) decreased with age, but the mortality rate increased inversely (from 5.0 to 13.5%). Under a similar condition and proportion of age-associated comorbidities after a well-batched PSM analysis, elderly patients had significantly higher mortality rates (8.0% vs. 1.9%, p < 0.001), higher complication rates (35.1% vs. 30.6%, p < 0.001), longer hospital LOS (8.9 vs. 8.1 days, p < 0.001), longer ICU LOS (3.7 vs. 2.7 days, p < 0.001) and more ventilator days (1.1 vs. 0.5 days, p < 0.001) than young patients. Furthermore, the MLR analysis showed that age itself served as an independent factor for mortality (odds ratio: 1.049, 95% CI 1.043–1.055, p < 0.001), but age-associated comorbidity was not. CONCLUSION: In patients with BAT, age itself appeared to have an independent and deleterious effect on mortality, but age-associated comorbidity did not. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00068-020-01595-8.