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Lengthy hospitalization associated with vertebral fractures despite control for comorbid conditions
A Papaioannou1, J D Adachi, W Parkinson
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada. papaioannou@hhsc
Insights
Vertebral fractures significantly increase hospital stays in older Canadians, contributing substantially to length of stay (LOS) even when controlling for other health issues. These fractures are a major factor in healthcare resource utilization.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Orthopedic Surgery
Background:
- Length of hospital stay (LOS) is a critical metric for healthcare resource utilization.
- Vertebral fractures are common in older adults and may significantly impact LOS.
- The independent contribution of vertebral fractures to LOS versus comorbid conditions requires clarification.
Purpose of the Study:
- To determine the extent to which vertebral fractures, independent of comorbidities, contribute to LOS in Canadians aged 50 and older.
- To compare the impact of vertebral fractures on LOS with other major health conditions.
Main Methods:
- A case-control study design was employed using data from the Canadian Institute for Health Information (CIHI) database.
- Hospital discharge data from Ontario, Alberta, and British Columbia between 1996 and 1997 were analyzed.
- Multivariate linear regression was used to assess the independent contribution of vertebral fractures to LOS, controlling for demographic and clinical factors.
Main Results:
- The mean LOS for patients admitted for vertebral fractures was 10.1 days.
- Vertebral fractures alone accounted for 4.8 to 6.1 days of LOS, depending on age.
- Comorbid vertebral fractures added 2.1 days to LOS for patients admitted for other conditions.
- Vertebral fractures ranked among the top three conditions, alongside hip fractures and mental disorders, in their contribution to LOS.
Conclusions:
- Vertebral fractures represent a significant independent factor contributing to prolonged hospital stays in older adults.
- Healthcare resource allocation must consider the substantial impact of vertebral fractures on LOS.
- Further research into interventions to reduce LOS associated with vertebral fractures is warranted.
Abstract:
This study established whether length of hospital stay (LOS) in Canadians 50 years and older is attributable to their vertebral fractures versus comorbid conditions. The study used a case-control design and data in the Canadian Institute for Health Information (CIHI) database on hospital discharges in Ontario, Alberta, and British Columbia between April 1, 1996 and March 31, 1997. Patients with vertebral fractures were identified by International Classification of Diseases (ICD-9) codes. LOS constituted the dependent measure in a multivariate linear regression that calculated the independent contributions to LOS by vertebral fractures while controlling for: age, gender, province, discharged deceased, hip fractures, all other fractures, motor vehicle accidents, all other injuries, and the major disorder classifications in ICD-9. Mean LOS for all patients admitted for vertebral fractures was 10.1 days. LOS attributed solely to vertebral fractures was 4.8 days based on a 50-year-old woman with no comorbid conditions, and 6.1 days based on a 75-year-old woman. Of 18 health conditions, vertebral fractures were among the top 3 in accounting for LOS, along with hip fractures and mental disorders which accounted for 5.9 days and 6.1 days in a 50-year-old woman. Among patients admitted for other problems, comorbid vertebral fractures added 2.1 days. These findings indicate that hospital stays for vertebral fractures are lengthy despite control for comorbidity.
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