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Hospital readmission after hip fracture

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Readmission to the hospital following a hip fracture is common, often involves an adverse event, and strains an already overburdened health care system.

Objectives

To assess the rate of 30-day readmission to the hospital after discharge for care of hip fracture. A secondary objective was measurement of the 30-day mortality rate for those patients readmitted versus those patients not readmitted to the hospital after discharge.

Materials and methods

Study design was a retrospective review of registry data comparing readmitted patients to those not readmitted after hip fracture. Setting was a university affiliated level 3 trauma center. Participants: 1,081 patients aged 65 and older. Measurements: rate of readmission, rate of mortality, predictors of readmission.

Results

129 patients (11.9 %) were readmitted to the hospital within 30 days of their initial discharge date. The primary causes of readmission were surgical in nature for 24/129 (18.6 %) patients and 105/129 (81.4 %) were readmitted for medical or other reasons. Twenty-four (18.6 %) patients who were readmitted died during readmission. The one-year mortality rate for patients readmitted within 30 days was 56.2 vs. a 21.8 % 1-year mortality rate for those patients not readmitted (p < 0.0001). Independent predictors of readmission were age >85 (OR = 1.52; p = 0.03), time to surgery >24 h (OR = 1.50; p = 0.05), Charlson score ≥4 (OR = 1.70; p = 0.04), delirium (OR = 1.65; p = 0.01), dementia (OR = 1.61; p = 0.01), history of arrhythmia with pacemaker placement (OR = 1.75; p = 0.02), and presence of a pre-op arrhythmia (OR = 1.62; p = 0.02).

Conclusion

Readmission after hip fracture is harmful and undesirable—18.6 % of readmitted patients died during their readmission and the average length of stay was 8.7 days. Approximately one of every six readmissions was identified as potentially preventable with interventions.

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Acknowledgments

The authors would like to acknowledge assistance provided by Mary Sears, LPN for data management and collection. There was no direct support provided for this study. Partial program support was provided by an unrestricted grant from Synthes Spine paid to the hospital.

Conflict of interest

The hospital program has received institutional support from Synthes Spine to assist with data collection. No direct support of any kind was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA

    Stephen L. Kates

  2. Carilion Clinic Orthopaedics, 3 Riverside Circle, Roanoke, VA, 24016, USA

    Caleb Behrend

  3. Division of Geriatrics, Department of Medicine, University of Rochester, 1000 South Ave., Rochester, NY, 14620, USA

    Daniel A. Mendelson & Susan M. Friedman

  4. Division of General Internal Medicine, University of Toronto, 200 Elizabeth Street, Eaton North, 14th Floor, Rm 216, Toronto, ON, M5G 2C4, Canada

    Peter Cram

Authors
  1. Stephen L. Kates
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  2. Caleb Behrend
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  3. Daniel A. Mendelson
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  4. Peter Cram
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  5. Susan M. Friedman
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Corresponding authors

Correspondence to Stephen L. Kates or Susan M. Friedman.

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Kates, S.L., Behrend, C., Mendelson, D.A. et al. Hospital readmission after hip fracture. Arch Orthop Trauma Surg 135, 329–337 (2015). https://doi.org/10.1007/s00402-014-2141-2

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  • DOI: https://doi.org/10.1007/s00402-014-2141-2

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