Comorbidities in major trauma patients in New Zealand: A retrospective cohort study of prevalence and associations with healthcare utilisation, mortality and cost.
TL;DR
The findings of this study suggest that it is important to consider prevention, not only with regard to trauma, but also in relation to comorbidities, to reduce the burden on individuals and the healthcare system.
Abstract
INTRODUCTION The prevalence of chronic health conditions is increasing in New Zealand (NZ) and internationally. This means that more people entering the health system for an acute event, such as major trauma, are likely to have other health conditions (i.e. comorbidities) that may impact their healthcare needs, outcomes and/or cost. This study examines comorbidities among major trauma patients injured in NZ between 2018 and 2022.
Methods
In this retrospective cohort study, records were linked between Te Rēhita Whētuki o Aotearoa, the New Zealand Trauma Registry and the National Minimum Dataset of hospital discharges for those who experienced a major trauma event (Injury Severity Score (ISS) > 12 or had died in hospital following trauma) in NZ during 2018-2022. Comorbidities were determined using the Multimorbidity Index (M3) using a five-year lookback from the date of discharge.
Results
Over 5 years, 11,768 patients were hospitalised for major trauma in NZ. Over half of these (54%) had at least one comorbidity as assessed by the M3. Of those hospitalised with major trauma in 2018, 53% had at least one comorbidity, rising to 56% in 2022. Comorbidities typically resulted in longer length of stay, longer length of ICU stay, longer hours on a ventilator and higher in-hospital and 12-month post-discharge mortality. For example, for the 5143 with serious injury (ISS 16-24), median length of stay was 6 days for those with no comorbidities (M3 =0) and 18 days for those with an M3 > 2; median length of ICU stay was 39 h for those with no comorbidities (M3 =0), and 116 h for those with an M3 > 2. Publicly-funded healthcare costs tended to be higher for those with more comorbidities.
Discussion
The increasing presence of comorbidities has implications for patient care, complexity and healthcare needs of those hospitalised following major trauma. As well as having implications for health service delivery, the findings of this study suggest that it is important to consider prevention, not only with regard to trauma, but also in relation to comorbidities, to reduce the burden on individuals and the healthcare system.