Higher Readmission Rates After Hip Fracture Among Patients With Vestibular Disorders

Abstract

Objective:Falls in older adults are associated with high morbidity and mortality. Patients with vestibular disorders may have an increased risk. The purpose of this study was to examine the outcomes among patients with underlying vestibular disorders who have hip fractures and identify predictors of increased morbidity and mortality.Study design:Retrospective cohort study.Setting:Tertiary care academic medical center.Patients:Two hundred one adults diagnosed with a vestibular disorder and hip fracture due to a ground-level fall were compared to 327 age- and sex-matched controls with fractures due to ground-level falls without vestibular diagnoses. Patients were treated between 2013 and 2019.Main outcome measures:Length of hospital stay, 30-day readmission rate, and 30-day mortality rate.Results:Thirty-day readmission rate after hip fracture was significantly increased in patients with vestibular disorders compared to matched controls (p < 0.001), odds ratio 3.12 (95% confidence interval 1.84–5.39). Reasons for readmission in the vestibular patient group included higher rates of repeat falls, infections, and recurrent vestibular symptoms. Use of medication classes associated with falls or hip fractures was not significantly different between groups, except for lower rates of antihypertensive use in the vestibular group (54.0% vs. 67.7%, p = 0.002). No significant difference was found for length of hospital stay (7.34 ± 4.95 vs. 8.14 ± 20.50 days, p = 0.51) or 30-day mortality rate (5.0% vs. 4.6%, p = 0.99). No significant differences were found between groups for age, sex, race, rate of surgical treatment for hip fracture, or disposition at discharge.Conclusions:Patients with vestibular disorders are at a significantly higher risk of hospital readmission within 30 days after discharge for treatment for hip fracture.

Effects of Frailty on Outcomes Following Surgery Among Patients With Hip Fractures: A Systematic Review and Meta-Analysis

“…Readmission rate is an important indicator of medical quality and the Hospital Readmission Reduction Program is used to punish high readmission rate ( 42 ). Early postoperative readmission of patients with hip fracture not only increases the risk of death, but also increases the economic burden and social medical burden of patients ( 43 ). Patients may be admitted to different medical facilities within 30 days of discharge, and this information is difficult to obtain.…”

Pitfalls, patience and patients: developing a physiotherapy-led balance clinic

“…Dizziness, balance dysfunction and vestibular conditions are a major problem, causing significant distress [1][2][3][4] and requiring significant resources. 5,6 Across Europe, there are a wide range of services delivering vestibular rehabilitation, within different specialisms, led by different professions, but such services have been identified as hard to access in the majority of cases. 7 This diversity of specialisms within which vestibular rehabilitation was being delivered was also reflected in a UK study; 8 that study highlighted some areas of poor implementation of best practice, and noted a trend that working in a specialist vestibular service enhanced evidence-based awareness.…”