Abstract
Introduction
Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients.
Materials methods
A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010–2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D’aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses.
Results
8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1–3.4), grade III–IV ASA (HR 2.1, 95 % CI 1.1–4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4–9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III–IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III–IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5–2.3).
Conclusions
Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.
Similar content being viewed by others
References
Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374
Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br 91:922–927
Pollock FH, Bethea A, Samanta D, Modak A, Maurer JP, Chumbe JT (2015) Readmission within 30 days of discharge after hip fracture care. Orthopedics 38:7–13
Ottenbacher KJ, Smith PM, Illig SB, Peek MK, Fiedler RC, Granger CV (2003) Hospital readmission of persons with hip fracture following medical rehabilitation. Arch Gerontol Geriatr 36:15–22
Librero J, Peiró S, Ordiñana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. Clin Epidemiol 52:171–179
Härstedt M, Rogmark C, Sutton R, Melander O, Fedorowski A (2014) Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery. Injury. doi:10.1016/j.injury.2014.12.024
Boockvar KS, Halm EA, Litke A, Silberzweig SB, McLaughlin M, Penrod JD, Magaziner J, Koval K, Strauss E, Siu AL (2003) Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc 51:399–403
French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ (2008) Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc 56:705–710
Khan MA, Hossain FS, Dashti Z, Muthukumar N (2012) Causes and predictors of early re-admission after surgery for a fracture of the hip. J Bone Joint Surg Br 94:690–697
Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM (2015) Hospital readmission after hip fracture. Arch Orthop Trauma Surg 135:329–337
Basques BA, Bohl DD, Golinvaux NS, Leslie MP, Baumgaertner MR, Grauer JN (2015) Postoperative length of stay and thirty-day readmission following geriatric hip fracture: an analysis of 8,434 patients. J Orthop Trauma 29:115–120
Katz S, Ford A, Moskowitz R, Jackson B, Jaffe M (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 185:914–919
Merle D’Aubigné R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475
Hodkinson HM (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 4:233–238
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251
American Society of Anesthesiologists (2008) Relative value guide. http://www.asahq.org. Accessed 10 Jan 2010
Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J (2005) Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc 53:1476–1482
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, Milisen K (2011) Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc 59:1299–1308
Hahnel J, Burdekin H, Anand Y (2009) Readmission following hip fracture surgery. Ann R Coll Engl 91:591–595
Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer M, Dodel R, Ruchholtz S (2013) Re-admission to level 2 unit after hip-fracture surgery: risk factors, reasons and outcome. Injury 44:1919–1925
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The study approved by IRB. Informed consent was not required.
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Lizaur-Utrilla, A., Serna-Berna, R., Lopez-Prats, F.A. et al. Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis. Arch Orthop Trauma Surg 135, 1663–1667 (2015). https://doi.org/10.1007/s00402-015-2328-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-015-2328-1