Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay

Age Ageing. 2009 Sep;38(5):584-9. doi: 10.1093/ageing/afp124. Epub 2009 Jul 13.

Abstract

Background: in older patients, there is a high risk of hospital readmission within the first year after surgery for hip fracture, due to complications following treatment or to the evolution of prior comorbid conditions.

Objectives: to identify factors associated with readmissions related to the index surgical stay.

Design: retrospective cohort study.

Setting: administrative claims databases.

Subjects: patients over 75 surgically treated for hip fracture in Paris area.

Methods: we analysed all admissions in 2005, and tracked for 1-year readmissions. First readmissions (FRs) were classified as related or unrelated to the index stay, according to rules defined a priori. We analysed the association between patient characteristics and the FR.

Results: among 5,709 patients, 32% had at least one readmission, 53% were FR related. Near 80% of related readmissions occurred within 3 months from discharge. Surgical conditions caused 47% of all related readmissions, and male gender, dementia, cancer or kidney diseases were independent risks factors.

Conclusions: half of readmissions could be classified as related to the index stay and a great majority of these occurred early post discharge. Surgical conditions caused 47% of all related readmissions. Improvement in orthopedic-geriatric co-care is suitable to expect an impact on outcomes after surgery.

MeSH terms

  • Acute Disease
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Dementia / epidemiology
  • Female
  • Hip Fractures / epidemiology*
  • Hip Fractures / surgery*
  • Hospital Information Systems
  • Hospitals, Public / statistics & numerical data
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Multivariate Analysis
  • Outcome Assessment, Health Care*
  • Patient Readmission / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution