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In-hospital mortality after hip fracture by treatment setting
Katie J Sheehan1, Boris Sobolev2, Pierre Guy2
1School of Population and Public Health (Sheehan, Sobolev, Sutherland) and Department of Orthopedics (Guy), University of British Columbia, Vancouver, BC; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Medicine (Morin), McGill University, Montréal, Que.; Department of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Department of Anesthesiology, Pharmacology and Therapeutics (Griesdale), University of British Columbia, Vancouver, BC; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Division of Orthopaedic Surgery and Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey), McGill University, Montréal, Que. sheehakj@mail.ubc.ca boris.sobolev@ubc.ca.
Insights
Hip fracture patients treated at smaller community hospitals face higher in-hospital death risks. Medium community hospitals also show increased post-surgery death rates compared to teaching hospitals.
Area of Science:
- Geriatric Medicine
- Health Services Research
- Orthopedic Surgery
Background:
- Patient outcomes following hip fracture treatment can be influenced by the healthcare setting.
- This study investigates the association between treatment location and in-hospital mortality for hip fractures in Canada.
Purpose of the Study:
- To compare the risk of in-hospital death after hip fracture based on the type of hospital (teaching vs. community).
- To analyze differences in mortality rates between various sizes of community hospitals and teaching hospitals.
Main Methods:
- Utilized Canadian Institute for Health Information discharge abstracts for patients aged 65+ with nonpathological hip fractures (2004-2012).
- Compared in-hospital death risk, overall and post-surgery, between teaching and community hospitals (large, medium, small), adjusting for length of stay.
Main Results:
- Medium and small community hospitals had significantly higher overall in-hospital death rates compared to teaching hospitals (ORs 1.16 and 1.44, respectively).
- The risk of post-surgery death was higher in medium community hospitals (OR 1.13) but not in small community hospitals compared to teaching hospitals.
- No significant difference in in-hospital death risk was observed between teaching and large community hospitals.
Conclusions:
- Treatment at medium and small community hospitals is associated with increased in-hospital mortality for hip fracture patients.
- Medium community hospitals also present a higher risk of post-surgical death.
- Further research is recommended to explore factors like hospital volume, demand, and bed occupancy contributing to these disparities.
Background:
Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.
Methods:
We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.
Results:
Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.
Interpretation:
Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.
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