Factors Affecting Mortality and Hospital Admissions after Hip Surgery among Elderly Patients with Hip Fracture in Hong Kong – Review of a Three-Year Follow-Up

Abstract

ObjectiveHip fracture is associated with excess mortalities and high rate of hospital re-admission after discharge from the indexed episode. To improve related post-discharge care, we aimed to find out characteristics that were associated with related higher rates of mortality and hospital re-admission.MethodsThis was a historical cohort study with following up of 273 patients recruited in a local rehabilitation hospital for 3 years. The outcome of interest was cumulative mortalities and hospital re-admissions in the 1st 3 years after their discharge from the rehabilitation hospital. These outcomes were collected in the hospital data warehouse — the Clinical Data Analysis and Reporting System (CDARS). Eighteen predictors, as proposed by similar studies and our own review, were retrieved from our standard clinical forms as well as from the CDARS. Binary logistic regression was used to test their association with the outcomes and to generate the respective odd ratios.ResultsThe cumulative overall mortality rates at 0.5-, 1-, 2- and 3- year after hip fracture were 7.2%, 14.0%, 24.6% and 33.4% respectively, while the cumulative “1st ever hospital read-mission” at 0.5-, 1, 2- and 3- years after hip fracture were 29.4%, 41.6%, 59.4% and 71.7% respectively. The most significant predictors i) for mortality at 3- year were: “Being male” (OR 5.33), “Delayed surgery >48 hours” (OR 2.65), “pre-operation albumin level <3.5 g/dl” (OR 2.66), and, ii) for “1st ever hospital readmission” at 0.5-year was “Being Assisted walker or non-walker (after rehabilitation)” (OR 3.83).ConclusionsCharacteristics that define the groups of patients with hip fractures with higher mortality and rate of hospital re-admission were identified. This could help healthcare professionals to focus on target patient groups for closer monitoring and more intensive post-discharge care.

Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors

“…Hip fracture in the elderly is an important problem that can lead to death. Many studies reported the mortality rates of hip surgery after 1 year ranged from 12.7 to 29.2% [5][6][7][8]. In our study, the total mortality rate 1 year after injury was 16.6%, similar to those reported previously.…”

Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score

“…The original cohort of patients in which the NHFS was designed had a mean age 2.8 years (3.4%) younger, 5.5% fewer males and 1.6% higher 30-day mortality than this cohort. 5 Whilst increasing age and male sex are risk factors for postoperative mortality, 19,20 the improved survival rate observed in our population may be attributed to the introduction of the BPT (Best Practice Tariff) in 2010. 21 The BPT uses monetary incentives to ensure standards are met and provide the best quality of care.…”

Prediction of Postoperative Outcomes Following Hip Fracture Surgery: Independent Validation and Recalibration of the Nottingham Hip Fracture Score

“…The original cohort of patients in which the NHFS was designed had a mean age 2.8 years (3.4%) younger, 5.5% fewer males and 1.6% higher 30-day mortality than this cohort. 5 Whilst increasing age and male sex are risk factors for postoperative mortality, 21,22 the improved survival rate observed in our population may be attributed to the introduction of the BPT (Best Practice Tariff) in 2010. 23 The BPT uses monetary incentives to ensure standards are met and provide the best quality of care.…”