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Time trends in hospital stay after hip fracture in Canada, 2004–2012: database study

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Abstract

Summary

Changes in bed management and access policy aimed to shorten Canadian hip fracture hospital stay. Secular trends in hip fracture total, preoperative, and postoperative stay are unknown. Hip fracture stay shortened from 2004 to 2012, mostly from shortening postoperative stay. This may reflect changes in bed management rather than access policy.

Purpose

To compare the probability of discharge by time after patient admission to hospital with first-time hip fracture over a period of nine calendar years.

Methods

We retrieved acute hospitalization records for 169,595 patients 65 years and older, who were admitted to an acute care hospital with hip fracture between 2004 and 2012 in Canada (outside of Quebec). The main outcome measure was cumulative incidence of discharge by inpatient day, accounting for competing events that end hospital stay.

Results

The probability of surgical discharge within 30 days of admission increased from 57.2 % in 2004 to 67.3 % in 2012. The probability of undergoing surgery on day of admission or day after fluctuated around 58.5 % over the study period. For postoperative stay, the discharge probability increased from 6.8 to 12.2 % at day 4 after surgery and from 57.2 to 66.6 % at day 21 after surgery, between 2004 and 2012. The differences across years persisted after adjustment for characteristics of patients, fracture, comorbidity, treatment, type and timing of surgery, and access to care.

Conclusions

Hospital stay following hip fracture shortened substantially between 2004 and 2012 in Canada, mostly due to shortening of postoperative stays. Shorter hospital stays may reflect changes in bed management protocols rather than in access policy.

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Acknowledgments

We gratefully acknowledge the guidance from the CIHI experts in understanding the discharge abstracts.

Author information

Author notes

    Authors and Affiliations

    1. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

      Boris Sobolev, Katie Jane Sheehan & Jason M. Sutherland

    2. Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada

      Pierre Guy

    3. Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada

      Lisa Kuramoto

    4. Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada

      Eric Bohm

    5. Departments of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada

      Lauren Beaupre

    6. Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada

      Michael Dunbar

    7. Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada

      Donald Griesdale

    8. Department of Medicine, McGill University, Montréal, QC, Canada

      Suzanne N. Morin

    9. Division of Orthopaedic Surgery, McGill University, Montréal, QC, Canada

      Edward Harvey

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    for The Canadian Collaborative Study on Hip Fractures

    Corresponding author

    Correspondence to Boris Sobolev.

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    Funding source

    This research was funded by the Canadian Institute for Health Research. This funder had no role in the design of this study, execution, analyses, data interpretation, or decision to submit results for publication.

    Conflicts of interest

    The following competing interests are declared: (1) PG has received grants from the Canadian Institutes of Health Research related to this work. PG also receives funding from the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation, and the British Columbia Specialists Services Committee for work around hip fracture care not related to this manuscript. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopedics (as a product development consultant). He is a board member and shareholder in Traumis Surgical Systems Inc. and a board member for the Canadian Orthopedic Foundation. He also serves on the speakers’ bureaus of AO Trauma North America and Stryker Canada. (2) SNM reports grants from Amgen Canada, grants from Merck, personal fees from Amgen Canada, and personal fees from Eli Lilly outside the submitted work. (3) KS is a postdoctoral fellow whose salary is paid by Canadian Institutes of Health Research funding related to this work. (4) BS, LK, EB, LB, JMS, MD, DG, EH declare that they have no conflicts of interest.

    Additional information

    The following are members of the Canadian Collaborative Study on Hip Fractures: Eric Bohm, Lauren Beaupre, Michael Dunbar, Donald Griesdale, Pierre Guy, Edward Harvey, Erik Hellsten, Susan Jaglal, Hans Kreder, Lisa Kuramoto, Adrian Levy, Suzanne N. Morin, Katie Jane Sheehan, Boris Sobolev, Jason M. Sutherland, and James Waddell.

    Boris Sobolev and Pierre Guy contributed equally to this work.

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    Sobolev, B., Guy, P., Sheehan, K.J. et al. Time trends in hospital stay after hip fracture in Canada, 2004–2012: database study. Arch Osteoporos 11, 13 (2016). https://doi.org/10.1007/s11657-016-0264-5

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