Archives of Osteoporosis

, 11:13 | Cite as

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

  • Boris Sobolev
  • Pierre Guy
  • Katie Jane Sheehan
  • Lisa Kuramoto
  • Eric Bohm
  • Lauren Beaupre
  • Jason M. Sutherland
  • Michael Dunbar
  • Donald Griesdale
  • Suzanne N. Morin
  • Edward Harvey
  • for The Canadian Collaborative Study on Hip Fractures
Original Article

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.

Keywords

Hip fracture Length of stay Postoperative stay Time trends Cumulative incidence Competing risks 

Supplementary material

11657_2016_264_MOESM1_ESM.doc (30 kb)
Additional File 1(DOC 30 kb)
11657_2016_264_MOESM2_ESM.doc (190 kb)
Additional File 2(DOC 189 kb)

References

  1. 1.
    Sutherland JM, Crump RT (2013) Alternative level of care: Canada’s hospital beds, the evidence and options. Healthc Policy 9:26–34PubMedPubMedCentralGoogle Scholar
  2. 2.
    Barrett B, Way C, McDonald J, Parfrey P (2005) Hospital utilization, efficiency and access to care during and shortly after restructuring acute care in Newfoundland and Labrador. J Health Serv Res Policy 10(Suppl 2):S2–S7CrossRefGoogle Scholar
  3. 3.
    Evans B, Potvin C, Johnson G, Henderson N, Yuen I, Smith T, Metham S, Taylor S, Sniekers D (2011) Enhancing patient flow in an acute care hospital: successful strategies at the Juravinski Hospital. Healthc Q 14:66–74CrossRefPubMedGoogle Scholar
  4. 4.
    Barrett J, Doyle W, Higgins D (2008) Corporate patient flow: “changing a culture through strategic planning and Accreditation Canada”. http://www.healthcarecan.ca/wp-content/uploads/2014/07/Changing-a-culture-though-strategic-planning-and-Accreditation-Canad.pdf Accessed 24 July 2015
  5. 5.
    Waddell J, McMullan J, Lo N, OConnor M, Sheppard L, Mensour M, Palda V, McGlasson R (2010) Improving time to surgery—emergency room, preoperative and immediate postoperative clinical practice guidelines for the management of hip fracture patients. Bone & Joint Health Network. http://boneandjointcanada.com/wp-content/uploads/2014/05/ER-Pre-op-Clinical-Practice-Guidelines-20101101_Final.pdf Accessed 24 July 2015
  6. 6.
    Ontario Ministry of Health and Long-Term Care (2005) First ever common benchmarks will allow canadians to measure progress in reducing wait times. www.health.gov.on.ca/english/media/news_releases/archives/nr_05/nr_121205.html Accessed 24 July 2015
  7. 7.
    Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. JAMA 291:1738–1743CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, Misasi M (2015) The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study. Bone Joint J 97-B:383–390CrossRefPubMedGoogle Scholar
  9. 9.
    Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ho V, Hamilton BH, Roos LL (2000) Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 34:1499–1518PubMedPubMedCentralGoogle Scholar
  11. 11.
    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) 91:922–927CrossRefGoogle Scholar
  12. 12.
    Canadian Institute for Health Information (2007) Health Indicators 2007. CIHI, OttawaGoogle Scholar
  13. 13.
    Canadian Institute for Health Information (2011) Data quality documentation for external users: Discharge Abstract Database, 2010–2011. CIHI, OttawaGoogle Scholar
  14. 14.
    Ahmed I, Khan MA, Nayak V, Mohsen A (2014) An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients. J Orthop Traumatol 15:21–27CrossRefPubMedGoogle Scholar
  15. 15.
    Lee DJ, Elfar JC (2014) Timing of hip fracture surgery in the elderly. Geriatr Orthop Surg Rehabil 5:138–140CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fransoo R, Yogendran M, Olafson K, Ramsey C, McGowan KL, Garland A (2012) Constructing episodes of inpatient care: data infrastructure for population-based research. BMC Med Res Methodol 12:133CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kaboli PJ, Go JT, Hockenberry J, Glasgow JM, Johnson SR, Rosenthal GE, Jones MP, Vaughan-Sarrazin M (2012) Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Ann Intern Med 157:837–845CrossRefPubMedGoogle Scholar
  18. 18.
    Vidan MT, Sanchez E, Gracia Y, Maranon E, Vaquero J, Serra JA (2011) Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med 155:226–233CrossRefPubMedGoogle Scholar
  19. 19.
    Pintilie M (2006) Competing risks, a practical perspective. John Wiley & SonsGoogle Scholar
  20. 20.
    Klein JP, Andersen PK (2005) Regression modeling of competing risks data based on pseudovalues of the cumulative incidence function. Biometrics 61:223–229CrossRefPubMedGoogle Scholar
  21. 21.
    Bland JM, Altman DG (1998) Survival probabilities (the Kaplan-Meier method). BMJ 317:572Google Scholar
  22. 22.
    Gray B (2014) cmprsk: Subdistribution analysis of competing risks. http://CRAN.R-project.org/package=cmprsk Accessed 24 July 2015
  23. 23.
    Gerds T (2014) prodlim: Product-limit estimation for censored event history analysis. http://CRAN.R-project.org/package=prodlim Accessed 24 July 2015
  24. 24.
    Hojsgaard S, Halekoh U, Yan J (2006) The R package geepack for generalized estimating equations. J Stat Softw 15:1–11Google Scholar
  25. 25.
    R core team (2015) R: a language and environment for statistical computingGoogle Scholar
  26. 26.
    Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Hollenbeak CS (2012) Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am 94:9–17CrossRefPubMedGoogle Scholar
  27. 27.
    Auais M, Morin S, Nadeau L, Finch L, Mayo N (2013) Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporos Int 24(10):2713–2724CrossRefPubMedGoogle Scholar
  28. 28.
    Ban I, Palm H, Birkelund L, Eschen J, Kring S, Brix M, Troelsen A (2014) Implementing, adapting, and validating an evidence-based algorithm for hip fracture surgery. J Orthop Trauma 28:e21–e26CrossRefPubMedGoogle Scholar
  29. 29.
    Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489CrossRefPubMedGoogle Scholar
  30. 30.
    Ricci WM, Brandt A, McAndrew C, Gardner MJ (2015) Factors affecting delay to surgery and length of stay for patients with hip fracture. J Orthop Trauma 29:e109–e114CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340CrossRefPubMedGoogle Scholar
  32. 32.
    Tracey J, Forte T, Fagbemi J, Chaudhary Z (2007) Wait time for hip fracture surgery in Canada. Healthc Q 10:24–27CrossRefPubMedGoogle Scholar
  33. 33.
    Motohashi T, Hamada H, Lee J, Sekimoto M, Imanaka Y (2013) Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture. Health Policy 111:60–67CrossRefPubMedGoogle Scholar
  34. 34.
    Canadian Institute for Health Information (2005) Inpatient hospitalizations and average length od stay trends in Canada, 2003–2004 and 2004–2005. CIHI, OttawaGoogle Scholar
  35. 35.
    Canadian Institute for Health Information (2005) Hospital trends in Canada—results of a project to create a historical series of statistical and financial data for Canadian hospitals over twenty-seven years. CIHI, OttawaGoogle Scholar
  36. 36.
    Kralj B, Kantarevic J (2012) Primary care model enrolment and hospital length of stay in Ontario: patient rostering associated with reduced length of stay, significant health system savings. Ontario Medical Review. 16–19Google Scholar
  37. 37.
    OECD (2011) Average length of stay in hospitals. In: Health at a Glance 2011: OECD Indicators. OECD PublishingGoogle Scholar
  38. 38.
    Neuburger J, Harding KA, Bradley RJ, Cromwell DA, Gregson CL (2014) Variation in access to community rehabilitation services and length of stay in hospital following a hip fracture: a cross-sectional study. BMJ Open 4:e005469CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Nordstrom P, Gustafson Y, Michaelsson K, Nordstrom A (2015) Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 350:h696CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Williams N, Hardy BM, Tarrant S, Enninghorst N, Attia J, Oldmeadow C, Balogh ZJ (2013) Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre. Arch Osteoporos 8(1–2):150CrossRefPubMedGoogle Scholar
  41. 41.
    Holvik K, Ranhoff AH, Martinsen MI, Solheim LF (2010) Predictors of mortality in older hip fracture inpatients admitted to an orthogeriatric unit in Oslo, Norway. J Aging Health 22:1114–1131CrossRefPubMedGoogle Scholar
  42. 42.
    Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, Fuld J, Nolte E (2014) Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment. health services and delivery researchGoogle Scholar
  43. 43.
    Neuburger J, Currie C, Wakeman R, Tsang C, Plant F, De SB, Cromwell DA, van der Meulen J (2015) The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care 53:686–691CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Boddaert J, Cohen-Bittan J, Khiami F, Le MY, Raux M, Beinis JY, Verny M, Riou B (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One 9(1):e83795CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134:1261–1269CrossRefPubMedGoogle Scholar
  46. 46.
    Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889CrossRefPubMedGoogle Scholar
  47. 47.
    Ko FC, Morrison RS (2014) Hip fracture: a trigger for palliative care in vulnerable older adults. JAMA Intern Med 174:1281–1282CrossRefPubMedGoogle Scholar
  48. 48.
    Meier DE (2011) Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q 89:343–380CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • Boris Sobolev
    • 1
  • Pierre Guy
    • 2
  • Katie Jane Sheehan
    • 1
  • Lisa Kuramoto
    • 3
  • Eric Bohm
    • 4
  • Lauren Beaupre
    • 5
  • Jason M. Sutherland
    • 1
  • Michael Dunbar
    • 6
  • Donald Griesdale
    • 7
  • Suzanne N. Morin
    • 8
  • Edward Harvey
    • 9
  • for The Canadian Collaborative Study on Hip Fractures
  1. 1.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.Department of OrthopedicsUniversity of British ColumbiaVancouverCanada
  3. 3.Vancouver Coastal Health Research InstituteUniversity of British ColumbiaVancouverCanada
  4. 4.Division of Orthopaedic Surgery and Center for Healthcare InnovationUniversity of ManitobaWinnipegCanada
  5. 5.Departments of Physical Therapy and Division of Orthopaedic SurgeryUniversity of AlbertaEdmontonCanada
  6. 6.Division of Orthopaedic SurgeryDalhousie UniversityHalifaxCanada
  7. 7.Department of Anesthesiology, Pharmacology & TherapeuticsUniversity of British ColumbiaVancouverCanada
  8. 8.Department of MedicineMcGill UniversityMontréalCanada
  9. 9.Division of Orthopaedic SurgeryMcGill UniversityMontréalCanada

Personalised recommendations