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Length of hospital stay after hip fracture surgery and 1-year mortality

Osteoporosis International volume 30, pages 145–153 (2019)Cite this article

Abstract

Summary

There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.

Introduction

The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old.

Methods

We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge.

Results

A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21–30, 31–40, and 11–20 days groups, respectively (p value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14–2.12) against the reference group (11–20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals.

Conclusion

Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.

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Author information

Affiliations

  1. Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea

    J. Yoo, S. Kim, B.S. Kim, H. Choi & C.W. Won

  2. Clinical Research Center, Asan Medical Center, 88, 43-gil Olympic-ro, Songpa-gu, Seoul, South Korea

    J.S. Lee

  3. Elderly Frailty Research Center, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea

    D.Y. Song

  4. Department of Medicine, Graduate School, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea

    W.B. Kim

Authors
  1. J. Yoo
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  2. J.S. Lee
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  3. S. Kim
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  4. B.S. Kim
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  5. H. Choi
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  6. D.Y. Song
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  8. C.W. Won
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Corresponding author

Correspondence to C.W. Won.

Ethics declarations

This study was approved by the Kyung Hee University Hospital Research Ethics Committee (Approval ID: KHUH 2017-01-069).

Conflicts of interest

This study used NHIS-Senior data (NHIS-2017-2-328) made by NHIS. Jinho Yoo, Ji Sung Lee, Sunyoung Kim, Byung Sung Kim, Hyunrim Choi, Da Young Song, Won Beom Kim, and Chang Won Won declare no conflict of interest with NHIS.

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Yoo, J., Lee, J., Kim, S. et al. Length of hospital stay after hip fracture surgery and 1-year mortality. Osteoporos Int 30, 145–153 (2019). https://doi.org/10.1007/s00198-018-4747-7

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  • DOI: https://doi.org/10.1007/s00198-018-4747-7

Keywords

  • Frail elderly
  • Healthcare administrative claims
  • Hip fractures
  • Mortality