Madeline Kennedy

(Reuters Health) - Elderly patients with hip fractures may get better care at smaller hospitals, a new study suggests. Seniors with hip fractures waited longer for surgery and were more likely to be rehospitalized if they were treated at a major trauma center than if they went to a smaller emergency room, researchers found.

Seniors in level 1 trauma centers were also more likely to develop blood clots in their legs, compared to their peers who were treated in settings designed for less serious injuries, the researchers reported March 11 in the journal Medical Care.

Level 1 trauma centers have the resources to treat very serious injuries, said lead author Dr. David Metcalfe of Brigham and Women's Hospital in Boston.

"However, because they care for the most complex patients, these hospitals are often very busy. There is therefore a risk that some groups of patients might be disadvantaged or 'lost' in the system," Metcalfe told Reuters Health by email.

For example, patients with multiple injuries or bones breaking through skin may be treated before seniors with hip fractures.

Each year in the U.S. alone, more than 250,000 people aged 65 and older are hospitalized for hip fractures, according to the Centers for Disease Control and Prevention.

The study team used statewide data from California on 91,401 seniors hospitalized between 2007 and 2011. All were over age 65 and had surgery for hip fractures.

Overall, 6% were treated at a level 1 trauma center, 18% at a level 2 trauma center and 70% in a non-trauma center.

On average, patients stayed in the hospital for five days and waited one day for surgery.

Patients in level 1 trauma centers stayed for one day longer than those in the other settings and waited nearly eight hours longer for surgery.

Seniors treated at level 1 centers were 62% more likely to be readmitted to the hospital within a month of their surgery than seniors treated in level 2 or non-trauma settings.Seniors were also 32% more likely to develop blood clots in their legs at level 1 centers.

Patients at level 2 trauma centers had the same outcomes as those at non-trauma centers, the authors found. There was no difference between any of the groups in risk of death, bed sores, or pneumonia, however.

"We now know that it is important to treat patients with hip fractures as quickly as possible," said Metcalfe, noting that older adults who wait too long for treatment may be at risk for bed sores, blood clots, and lung infections.

"The concern is that this delay will lead to increasing length of stay in hospital as well as increased complications for the patients because they spend longer in bed waiting for surgery," said Dr. Chris Gooding, a surgeon at Addenbrookes Hospital, a level 1 trauma center in Cambridge, UK. Gooding was not involved in the study.

"This is an important subject as in developed countries we have an aging population and as a result we are seeing increasing numbers of patients with hip fractures," Gooding told Reuters Health by email.

At the same time, Gooding noted, there are also a growing number of level 1 trauma centers.

"One of the best ways to help these patients is to get their operation done quickly so that they can start walking again and return to their own homes as soon as possible," Metcalfe advised.

(Reuters Health) - Elderly patients with hip fractures may get better care at smaller hospitals, a new study suggests. Seniors with hip fractures waited longer for surgery and were more likely to be rehospitalized if they were treated at a major trauma center than if they went to a smaller emergency room, researchers found.

Seniors in level 1 trauma centers were also more likely to develop blood clots in their legs, compared to their peers who were treated in settings designed for less serious injuries, the researchers reported March 11 in the journal Medical Care.

Level 1 trauma centers have the resources to treat very serious injuries, said lead author Dr. David Metcalfe of Brigham and Women's Hospital in Boston.

"However, because they care for the most complex patients, these hospitals are often very busy. There is therefore a risk that some groups of patients might be disadvantaged or 'lost' in the system," Metcalfe told Reuters Health by email.

For example, patients with multiple injuries or bones breaking through skin may be treated before seniors with hip fractures.

Each year in the U.S. alone, more than 250,000 people aged 65 and older are hospitalized for hip fractures, according to the Centers for Disease Control and Prevention.

The study team used statewide data from California on 91,401 seniors hospitalized between 2007 and 2011. All were over age 65 and had surgery for hip fractures.

Overall, 6% were treated at a level 1 trauma center, 18% at a level 2 trauma center and 70% in a non-trauma center.

On average, patients stayed in the hospital for five days and waited one day for surgery.

Patients in level 1 trauma centers stayed for one day longer than those in the other settings and waited nearly eight hours longer for surgery.

Seniors treated at level 1 centers were 62% more likely to be readmitted to the hospital within a month of their surgery than seniors treated in level 2 or non-trauma settings.Seniors were also 32% more likely to develop blood clots in their legs at level 1 centers.

Patients at level 2 trauma centers had the same outcomes as those at non-trauma centers, the authors found. There was no difference between any of the groups in risk of death, bed sores, or pneumonia, however.

"We now know that it is important to treat patients with hip fractures as quickly as possible," said Metcalfe, noting that older adults who wait too long for treatment may be at risk for bed sores, blood clots, and lung infections.

"The concern is that this delay will lead to increasing length of stay in hospital as well as increased complications for the patients because they spend longer in bed waiting for surgery," said Dr. Chris Gooding, a surgeon at Addenbrookes Hospital, a level 1 trauma center in Cambridge, UK. Gooding was not involved in the study.

"This is an important subject as in developed countries we have an aging population and as a result we are seeing increasing numbers of patients with hip fractures," Gooding told Reuters Health by email.

At the same time, Gooding noted, there are also a growing number of level 1 trauma centers.

"One of the best ways to help these patients is to get their operation done quickly so that they can start walking again and return to their own homes as soon as possible," Metcalfe advised.

(Reuters Health) - Elderly patients with hip fractures may get better care at smaller hospitals, a new study suggests. Seniors with hip fractures waited longer for surgery and were more likely to be rehospitalized if they were treated at a major trauma center than if they went to a smaller emergency room, researchers found.

Seniors in level 1 trauma centers were also more likely to develop blood clots in their legs, compared to their peers who were treated in settings designed for less serious injuries, the researchers reported March 11 in the journal Medical Care.

Level 1 trauma centers have the resources to treat very serious injuries, said lead author Dr. David Metcalfe of Brigham and Women's Hospital in Boston.

"However, because they care for the most complex patients, these hospitals are often very busy. There is therefore a risk that some groups of patients might be disadvantaged or 'lost' in the system," Metcalfe told Reuters Health by email.

For example, patients with multiple injuries or bones breaking through skin may be treated before seniors with hip fractures.

Each year in the U.S. alone, more than 250,000 people aged 65 and older are hospitalized for hip fractures, according to the Centers for Disease Control and Prevention.

The study team used statewide data from California on 91,401 seniors hospitalized between 2007 and 2011. All were over age 65 and had surgery for hip fractures.

Overall, 6% were treated at a level 1 trauma center, 18% at a level 2 trauma center and 70% in a non-trauma center.

On average, patients stayed in the hospital for five days and waited one day for surgery.

Patients in level 1 trauma centers stayed for one day longer than those in the other settings and waited nearly eight hours longer for surgery.

Seniors treated at level 1 centers were 62% more likely to be readmitted to the hospital within a month of their surgery than seniors treated in level 2 or non-trauma settings.Seniors were also 32% more likely to develop blood clots in their legs at level 1 centers.

Patients at level 2 trauma centers had the same outcomes as those at non-trauma centers, the authors found. There was no difference between any of the groups in risk of death, bed sores, or pneumonia, however.

"We now know that it is important to treat patients with hip fractures as quickly as possible," said Metcalfe, noting that older adults who wait too long for treatment may be at risk for bed sores, blood clots, and lung infections.

"The concern is that this delay will lead to increasing length of stay in hospital as well as increased complications for the patients because they spend longer in bed waiting for surgery," said Dr. Chris Gooding, a surgeon at Addenbrookes Hospital, a level 1 trauma center in Cambridge, UK. Gooding was not involved in the study.

"This is an important subject as in developed countries we have an aging population and as a result we are seeing increasing numbers of patients with hip fractures," Gooding told Reuters Health by email.

At the same time, Gooding noted, there are also a growing number of level 1 trauma centers.

"One of the best ways to help these patients is to get their operation done quickly so that they can start walking again and return to their own homes as soon as possible," Metcalfe advised.

(Reuters Health) - Women who develop diabetes while pregnant may be at elevated risk of also developing a dangerous build up of fat in their livers when they reach middle age, according to a new analysis.

The common risk factor for both gestational diabetes and non-alcoholic fatty liver disease, researchers say, is trouble making or using the hormone insulin to manage blood sugar, known as insulin resistance.

"We hope that early identification can promote healthy lifestyle changes that prevent or slow disease progression," said lead author Dr. Veeral Ajmera of the University of California, San Francisco.

"Pregnancy stresses the body in many ways, one of which is the ability to manage blood sugar," Ajmera said by email. "During pregnancy a woman's body becomes more resistant to insulin, which is the hormone required to decrease the blood sugar."

Insulin resistance is also "central to development of non-alcoholic fatty liver disease," which affects 20 percent to 30 percent of adults in the western world, the study team writes in The American Journal of Gastroenterology. Non-alcoholic fatty liver disease is the most common chronic liver disease in the United States.

Fatty liver disease is often diagnosed later in life, Ajmera told Reuters Health. So the researchers used long-term data to see if diabetes during pregnancy made a woman more likely to develop fatty liver disease 25 years later.

The researchers analyzed information about 1,115 black and white women recruited between 1985-1986 in four cities across the United States who gave birth to at least one child.

The participants did not have diabetes before becoming pregnant and the study excluded people who had liver issues related to alcohol, HIV, hepatitis or medications.

At the start of the study, women reported on whether they first experienced diabetes during pregnancy, and researchers confirmed the diagnosis with blood test results. Twenty-five years later, the women received more blood tests as well as CT scans of their livers to check if they had fatty liver disease.

At the beginning of the study, 124 women reported that they developed diabetes while they were pregnant. These women were more likely than those who did not experience gestational diabetes to be overweight. They also had higher degrees of insulin resistance when they were younger as well as at the 25-year follow up.

The women who experienced diabetes during pregnancy were also more likely to have developed diabetes again at some point in the following 25 years.

Overall, 75 women were diagnosed with non-alcoholic fatty liver disease when they were middle aged. Women who had diabetes during pregnancy were more than twice as likely as those who didn't to later develop fatty liver disease.

After researchers adjusted for diabetes that some women experienced outside of pregnancy, the risk of non-alcoholic fatty liver disease was still 50 percent higher for women who had gestational diabetes compared to those who didn't.

Fatty liver disease can have grave health effects and can even lead to cirrhosis, a condition that causes liver damage and possible failure, said Simon Taylor-Robinson, a professor of medicine at Imperial College London in the U.K. who wasn't involved in the study.

He advocates changes in diet to avoid the insulin resistance that leads to diabetes and fatty liver disease. "Many women are obese - so it is a matter of reducing weight and eating sensibly," he said.

Taylor-Robinson recommends eating fewer carbohydrates, more proteins and vegetables, and in particular, avoiding large amounts of fruit juice, which can contain a lot of sugar.

Ajmera also advised lifestyle changes, especially adding exercise. "We recommend either aerobic or resistance training for 30 minutes five times per week," he said.

"There are consequences to obesity and this includes cirrhosis, liver cancer and heart disease," Taylor-Robinson said. "Those people who become diabetic during pregnancy have strong risks of developing these complications later in life if attention isn't given to weight, diet and exercise."

(Reuters Health) - Women who develop diabetes while pregnant may be at elevated risk of also developing a dangerous build up of fat in their livers when they reach middle age, according to a new analysis.

The common risk factor for both gestational diabetes and non-alcoholic fatty liver disease, researchers say, is trouble making or using the hormone insulin to manage blood sugar, known as insulin resistance.

"We hope that early identification can promote healthy lifestyle changes that prevent or slow disease progression," said lead author Dr. Veeral Ajmera of the University of California, San Francisco.

"Pregnancy stresses the body in many ways, one of which is the ability to manage blood sugar," Ajmera said by email. "During pregnancy a woman's body becomes more resistant to insulin, which is the hormone required to decrease the blood sugar."

Insulin resistance is also "central to development of non-alcoholic fatty liver disease," which affects 20 percent to 30 percent of adults in the western world, the study team writes in The American Journal of Gastroenterology. Non-alcoholic fatty liver disease is the most common chronic liver disease in the United States.

Fatty liver disease is often diagnosed later in life, Ajmera told Reuters Health. So the researchers used long-term data to see if diabetes during pregnancy made a woman more likely to develop fatty liver disease 25 years later.

The researchers analyzed information about 1,115 black and white women recruited between 1985-1986 in four cities across the United States who gave birth to at least one child.

The participants did not have diabetes before becoming pregnant and the study excluded people who had liver issues related to alcohol, HIV, hepatitis or medications.

At the start of the study, women reported on whether they first experienced diabetes during pregnancy, and researchers confirmed the diagnosis with blood test results. Twenty-five years later, the women received more blood tests as well as CT scans of their livers to check if they had fatty liver disease.

At the beginning of the study, 124 women reported that they developed diabetes while they were pregnant. These women were more likely than those who did not experience gestational diabetes to be overweight. They also had higher degrees of insulin resistance when they were younger as well as at the 25-year follow up.

The women who experienced diabetes during pregnancy were also more likely to have developed diabetes again at some point in the following 25 years.

Overall, 75 women were diagnosed with non-alcoholic fatty liver disease when they were middle aged. Women who had diabetes during pregnancy were more than twice as likely as those who didn't to later develop fatty liver disease.

After researchers adjusted for diabetes that some women experienced outside of pregnancy, the risk of non-alcoholic fatty liver disease was still 50 percent higher for women who had gestational diabetes compared to those who didn't.

Fatty liver disease can have grave health effects and can even lead to cirrhosis, a condition that causes liver damage and possible failure, said Simon Taylor-Robinson, a professor of medicine at Imperial College London in the U.K. who wasn't involved in the study.

He advocates changes in diet to avoid the insulin resistance that leads to diabetes and fatty liver disease. "Many women are obese - so it is a matter of reducing weight and eating sensibly," he said.

Taylor-Robinson recommends eating fewer carbohydrates, more proteins and vegetables, and in particular, avoiding large amounts of fruit juice, which can contain a lot of sugar.

Ajmera also advised lifestyle changes, especially adding exercise. "We recommend either aerobic or resistance training for 30 minutes five times per week," he said.

"There are consequences to obesity and this includes cirrhosis, liver cancer and heart disease," Taylor-Robinson said. "Those people who become diabetic during pregnancy have strong risks of developing these complications later in life if attention isn't given to weight, diet and exercise."

(Reuters Health) - Women who develop diabetes while pregnant may be at elevated risk of also developing a dangerous build up of fat in their livers when they reach middle age, according to a new analysis.

The common risk factor for both gestational diabetes and non-alcoholic fatty liver disease, researchers say, is trouble making or using the hormone insulin to manage blood sugar, known as insulin resistance.

"We hope that early identification can promote healthy lifestyle changes that prevent or slow disease progression," said lead author Dr. Veeral Ajmera of the University of California, San Francisco.

"Pregnancy stresses the body in many ways, one of which is the ability to manage blood sugar," Ajmera said by email. "During pregnancy a woman's body becomes more resistant to insulin, which is the hormone required to decrease the blood sugar."

Insulin resistance is also "central to development of non-alcoholic fatty liver disease," which affects 20 percent to 30 percent of adults in the western world, the study team writes in The American Journal of Gastroenterology. Non-alcoholic fatty liver disease is the most common chronic liver disease in the United States.

Fatty liver disease is often diagnosed later in life, Ajmera told Reuters Health. So the researchers used long-term data to see if diabetes during pregnancy made a woman more likely to develop fatty liver disease 25 years later.

The researchers analyzed information about 1,115 black and white women recruited between 1985-1986 in four cities across the United States who gave birth to at least one child.

The participants did not have diabetes before becoming pregnant and the study excluded people who had liver issues related to alcohol, HIV, hepatitis or medications.

At the start of the study, women reported on whether they first experienced diabetes during pregnancy, and researchers confirmed the diagnosis with blood test results. Twenty-five years later, the women received more blood tests as well as CT scans of their livers to check if they had fatty liver disease.

At the beginning of the study, 124 women reported that they developed diabetes while they were pregnant. These women were more likely than those who did not experience gestational diabetes to be overweight. They also had higher degrees of insulin resistance when they were younger as well as at the 25-year follow up.

The women who experienced diabetes during pregnancy were also more likely to have developed diabetes again at some point in the following 25 years.

Overall, 75 women were diagnosed with non-alcoholic fatty liver disease when they were middle aged. Women who had diabetes during pregnancy were more than twice as likely as those who didn't to later develop fatty liver disease.

After researchers adjusted for diabetes that some women experienced outside of pregnancy, the risk of non-alcoholic fatty liver disease was still 50 percent higher for women who had gestational diabetes compared to those who didn't.

Fatty liver disease can have grave health effects and can even lead to cirrhosis, a condition that causes liver damage and possible failure, said Simon Taylor-Robinson, a professor of medicine at Imperial College London in the U.K. who wasn't involved in the study.

He advocates changes in diet to avoid the insulin resistance that leads to diabetes and fatty liver disease. "Many women are obese - so it is a matter of reducing weight and eating sensibly," he said.

Taylor-Robinson recommends eating fewer carbohydrates, more proteins and vegetables, and in particular, avoiding large amounts of fruit juice, which can contain a lot of sugar.

Ajmera also advised lifestyle changes, especially adding exercise. "We recommend either aerobic or resistance training for 30 minutes five times per week," he said.

"There are consequences to obesity and this includes cirrhosis, liver cancer and heart disease," Taylor-Robinson said. "Those people who become diabetic during pregnancy have strong risks of developing these complications later in life if attention isn't given to weight, diet and exercise."