Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities

BMC Health Services Research

Robert G Cumming¹  Patrick J Kelly¹  Anthony W Ireland¹ 

[1] School of Public Health, Edward Ford Building, University of Sydney 2006, Sydney, New South Wales, Australia

关键词: Rehabilitation;    Residential aged care;    Complications;    Length of stay;    Hip fracture;   

Others  :  1089821
DOI  :  10.1186/s12913-015-0697-3

 received in 2014-04-29, accepted in 2015-01-12,  发布年份 2015

【 摘 要 】

Background

Hospital treatment for hip fracture is complex, often involving sequential episodes for acute orthopaedics, rehabilitation and care of contingent conditions. Most reports of hospital length of stay (LOS) address only the acute phase of care. This study identifies the frequency and mean duration of the component episodes within total hospital stay, and measures the impacts of patient-level and clinical service variables upon both acute phase and total LOS.

Methods

Administrative datasets for 2552 subjects hospitalised between 1 July 2008 and 30 June 2009 were linked. Associations between LOS, pre-fracture accommodation status, age, sex, fracture type, hospital separation codes, selected comorbidities and complications were examined in regression models for acute phase and total LOS for patients from residential aged care (RAC) and from the community.

Results

Mean total LOS was 30.8 days, with 43 per cent attributable to acute fracture management, 37 per cent to rehabilitation and 20 per cent to management of contingent conditions. Community patients had unadjusted total LOS of 35.4 days compared with 18.8 days for RAC patients (p <0.001). The proportion of transfers into rehabilitation (57 per cent vs 17 per cent, p <0.001) was the major determinant for this difference. In multivariate analyses, new RAC placement, discharge to other facilities, and complications of pressure ulcer, urinary or surgical site infections increased LOS by at least four days in one or more phases of hospital stay.

Conclusion

Pre-fracture residence, selection for rehabilitation, discharge destination and specific complications are key determinants for acute phase and total LOS. Calculating the dimensions of specific determinants for LOS may identify potential efficiencies from targeted interventions such as orthogeriatric care models.

【 授权许可】

   
2015 Ireland et al.; licensee BioMed Central.

【 参考文献 】

• [1]Hung WW, Egol KA, Zuckerman JD, Siu AL: Hip fracture management: tailoring care for the older patient. JAMA 2012, 307(20):2185-94.
• [2]Bookvar KS, Litke A, Penrod JD, Halm EA, Morrison RS, Silberzweigf SB, Magaziner J, Koval K, Siu AL: Patient relocation in the 6 months after hip fracture: risk factors for fragmented care. J Am Geriatr Soc 2004, 52(11):1826-31.
• [3]Sund R, Riihmäki M, Mäkelä M, Vehtari A, Lüthje P, Huusko T, Häkkinin U: Modelling the length of the care episode after hip fracture: does the type of fracture matter? Scand J Surg 2009, 98:169-74.
• [4]Ireland AW, Kelly PJ: Total length of stay, costs and outcomes at final discharge for admitted patients with hip fracture: linked episode data for Australian veterans and war widows. Intern Med J 2012, 43(12):1280-6.
• [5]Pioli G, Frondini C, Lauretani F, Davioli ML, Pellicciotti F, Martini E, Zadatti A, Giordana A, Pedriali I, Nardelli A, Zurio A, Ferrari A, Lunardelli ML: Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units. Archives of Gerontology and Geriatrics 2012, 55:316-22.
• [6]Bookvar KS, Halm EA, Litke A, Silberzweigf SB, McLaughlin M, Penrod JD, Magaziner J, Koval K, Strauss E, Siu AL: Hospital readmissions after hospital discharge for hip fracture: surgical and non-surgical causes and effective outcomes. J Amer Geriatr Soc 2003, 51(3):399-403.
• [7]Kammerlander C, Roth T, Friedman SM, Suhm N, Luger TJ, Kammerlander-Knauer U, Krappinger D, Blauth M. Ortho-geriatric service- a literature review comparing different models. Osteoporosis Int .2010. doi:10.1007/s00198-010-1396-x.
• [8]Fergus L, Cutfield G, Harris R: Auckland City Hospital’s orthogeriatric service: an audit of patients aged over 65 with fractured neck of femur. N Z Med J 2011, 124(1337):40-54.
• [9]Duclos A, Couray-Tange S, Randreanasolo M, Hedoux S, Couris CM, Colin C, Schott AM: Burden of hip fracture on inpatient care; a before-and-after population based study. Osteoporosis Int 2010, 21(9):1493-501.
• [10]Lofgren S, Ljunggren G, Brommels M: No ticking time bomb: Hospital utilisation of 28258 hip fracture patients in Stockholm during 1998-2007. Scand J Public Health 2010, 38:418-25.
• [11]DiMonaco M, Castiglioni C, Vallero F, Di Monaco R, Tappero R: Men recover ability to function less than women do: an observational study of 1094 subjects after hip fracture. Am J Phys Med Rehabi 2012, 91(4):309-15.
• [12]Holt G, Macdonald D, Fraser M, Reece AT: Outcome after surgery for fracture of the hip in patients aged over 95 years. Bone Joint J 2006, 88-B(8):1060-4.
• [13]Hommel A, Ulander K, Bjorkelund KB, Norrman P-O, Wingstrand H, Thorngren K-G: Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury 2008, 39(10):1164-74.
• [14]Nikkel LE, Fox EJ, Black KP, Davis C, Anderson L, Hollenbeak CS: Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am 2012, 94:9-17.
• [15]Chen JS, Sambrook PN, Simpsom JM, Cameron ID, Cumming RG, Seibel MJ, Lord BR, March LM: Risk factors for hip fracture among institutionalised older people. Age and Ageing 2009, 38(4):429-34.
• [16]Harris IA, Yong S, McEvoy L, Thorn L: A prospective study of the effect of nursing home residency on mortality following hip fracture. ANZ J Surg 2010, 80(6):447-50.
• [17]Commonwealth of Australia. Aged Care Assessment and Approval Guidelines, 2006. ISBN: 0 642 82128 3.
• [18]Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson Comorbidity Index predicted in-hospital mortality. J Clin Epidemiol. 2004;1288-1294.
• [19]Foss NB, Kristensen MT, Kehlet H: Anaemia impedes functional mobility after hip fracture surgery. Age and Ageing 2008, 37:173-8.
• [20]Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T: Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 2011, 131:1435-44.
• [21]Heinrich S, Rapp K, Rissmann U, Becker C, König HH: Service use and costs of incident femoral fractures in nursing home residents in Germany: the Bavarian Fall and fracture prevention Project (BF2P2). J Am Med Dir Assoc 2011, 12(6):459-66.
• [22]Jameson SS, Khan SK, Baker P, James P, Gray A, Deehan DJ: A national analysis of complications following hemiarthroplasty for hip fracture in older patients. Q J Med 2012, 105:455-60.
• [23]Poulos CJ, Magee C, Bashford G, Eagar K: Determining the appropriateness of the patient journey from acute care to rehabilitation. BMC Health Services Research 2011, 11:291. doi: 10-1186/1472-6963-11-291 BioMed Central Full Text
• [24]Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ. 2006; doi:10.1136/bmj.38790.468519.55 (Last accessed August 2013).
• [25]Rademakers LMF, Vainas T, van Zutphen SW, Brink PRG, van Helden SH: Pressure ulcers and prolonged hospital stay in hip fracture patients affected by time-to-surgery. Eur J Trauma Emerg Surgery 2007, 33:238-44.
• [26]Edwards C, Counsell A, Boulton C, Moran CG: Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg (Br). 2008, 90-B:770-7.
• [27]Sahota O, Morgan N, Moran CG: The direct cost of acute hip fracture care in care home residents in the UK. Osteoporosis Int 2012, 23:917-20.
• [28]Penrod JD, Litke MA, Hawke WG, Magaziner J, Koval K, Doucette JT, Silberzweig SB: Heterogeneity in hip fracture patients: age, functional status and comorbidity. J Amer Geriatr Soc 2007, 55(3):407-13.
• [29]Burleigh E, Smith R, Duncan K, Lennox I, Reid D: Does place of residence influence hospital rehabilitation and assessment of falls and osteoporosis risk following admission with hip fracture. Age Ageing 2011, 40:128-32.
• [30]Scandol JP, Toson B, Close JT: Fall-related hip fracture hospitalisations and the prevalence of dementia within older people in New South Wales, Australia: Analysis of linked data. Injury 2013, 44:776-83.
• [31]Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, Faiz OD: Systematic review of discharge coding accuracy. J Public Health 2012, 34(1):138-48.
• [32]Vidán MT, Sánchez E, Gracia Y, Maranõn E, Vaquero J, Serra JA: Causes and effects of surgical delay in patients with hip fracture. A cohort study. Ann Intern Med 2011, 155:226-33.
• [33]Björkelund KB, Hommel A, Thorgren K-G, Gustafson L, Larsson S, Lundberg D: Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiologica Scandinavia 2010, 54:678-88.
• [34]Juliebø V, Bjøro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB: Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Amer Geriatr Soc 2011, 57(8):354-1361.
• [35]Baumgarten M, Margolis DJ, Orwig DL, Strom BL, Garino J, Kagan SH, Kavesh W, Carson JL: Pressure ulcers in elderly patients with hip fractures across the continuum of care. J Amer Geriatr Soc 2009, 57(5):863-70.
• [36]Vu T, Day L, Finch CF. Linked versus unlinked hospital discharge data on hip fractures for estimating incidence and comorbidity profiles. BMC Medical Research Methodology. 2012. http://www.biomedcentral.com/1471-2288/12/113.