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. 2016 Dec 6;188(17-18):1219-1225.
doi: 10.1503/cmaj.160522. Epub 2016 Oct 17.

In-hospital mortality after hip fracture by treatment setting

Katie J Sheehan  1 , Boris Sobolev  2 , Pierre Guy  2 , Lisa Kuramoto  2 , Suzanne N Morin  2 , Jason M Sutherland  2 , Lauren Beaupre  2 , Donald Griesdale  2 , Michael Dunbar  2 , Eric Bohm  2 , Edward Harvey  2 ; Canadian Collaborative Study of Hip Fractures
Affiliations

In-hospital mortality after hip fracture by treatment setting

Katie J Sheehan et al. CMAJ. .

Abstract

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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Figures

Figure 1:
Figure 1:
Study population.
Figure 2:
Figure 2:
Cumulative incidence of in-hospital death by inpatient days across treatment settings among all patients admitted with first hip fracture.
See this image and copyright information in PMC

Comment in

References

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