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. 2015 Feb 20:350:h696.
doi: 10.1136/bmj.h696.

Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden

Peter Nordström  1 , Yngve Gustafson  2 , Karl Michaëlsson  3 , Anna Nordström  4
Affiliations

Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden

Peter Nordström et al. BMJ. .

Abstract

Objective: To investigate relation between inpatient length of stay after hip fracture and risk of death after hospital discharge.

Setting: Population ≥50 years old living in Sweden as of 31 December 2005 with a first hip fracture the years 2006-12.

Participants: 116,111 patients with an incident hip fracture from a closed nationwide cohort.

Main outcome measure: Death within 30 days of hospital discharge in relation to hospital length of stay after adjustment for multiple covariates.

Results: Mean inpatient length of stay after a hip fracture decreased from 14.2 days in 2006 to 11.6 days in 2012 (P<0.001). The association between length of stay and risk of death after discharge was non-linear (P<0.001), with a threshold for this non-linear effect of about 10 days. Thus, for patients with length of stay of ≤10 days (n=59,154), each 1-day reduction in length of stay increased the odds of death within 30 days of discharge by 8% in 2006 (odds ratio 1.08 (95% confidence interval 1.04 to 1.12)), which increased to16% in 2012 (odds ratio 1.16 (1.12 to 1.20)). In contrast, for patients with a length of stay of ≥11 days (n=56,957), a 1-day reduction in length of stay was not associated with an increased risk of death after discharge during any of the years of follow up.

Limitations: No accurate evaluation of the underlying cause of death could be performed.

Conclusion: Shorter length of stay in hospital after hip fracture is associated with increased risk of death after hospital discharge, but only among patients with length of stay of 10 days or less. This association remained robust over consecutive years.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Cumulative risk of death within 30 days of discharge for patients with a length of stay of 0–5 days, 6–10 days, 11–14 days, and ≥15 days. Patients who died during hospital stay were excluded
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Fig 2 Association between length of stay and risk of death within 30 days of hospital discharge for the years of follow-up. Patients who died during hospital stay were excluded. To model the effects of length of stay, restricted cubic splines with five knots were used (giving 4 degrees of freedom), followed by fitting a proportional hazards model with a length of stay of 12 days as reference.
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