Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter?

Sund, Reijo; Riihimäki, Jaakko; Mākelä, Marjukka; Vehtari, Aki; Lüthje, Peter; Huusko, Tiina; Häkkinen, Unto

doi:10.1177/145749690909800308

Cited by 33 publications

(31 citation statements)

References 22 publications

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“…Data on the associations between HF type and short-term outcomes are sparse and inconsistent, though some previous reports found a longer LOS [29,30] and higher mortality in trochanteric HF [7,15,17,34]. Our results are in line with observations that HF type is not an independent prognostic factor [43,49] and is not associated with LOS [15].…”

Section: Discussionsupporting

confidence: 90%

Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

Fisher

Srikusalanukul

Davis

et al. 2012

J Trauma Manage Outcomes

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BackgroundData on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type.MethodsProspective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined.ResultsThe cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF.ConclusionsClinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.

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Section: Discussionsupporting

confidence: 90%

Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

Fisher

Srikusalanukul

Davis

et al. 2012

J Trauma Manage Outcomes

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“…Equally wide utilisation differences have been reported in other contemporary studies, in which total hospital stay ranged from 17 to 48 days, 1,24 rates of referral to rehabilitation ranged from 21% to 67% 8,11 and mean duration of hospital-based rehabilitation was between 1 and 6 weeks. 24,25 A recent Australian study found significant differences between four states in terms of LOS for rehabilitation of specific classes of lower limb amputees.…”

Section: Discussionmentioning

confidence: 70%

“…[1][2][3] Comparisons of duration and content of hospital management at national, regional and facility levels show wide diversity. 1,4,5 Across the world, duration of hospital stay for hip fracture ranges from as little as 5 days 6 to more than 6 weeks. 1 regions.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,5 Across the world, duration of hospital stay for hip fracture ranges from as little as 5 days 6 to more than 6 weeks. 1 regions. 4,8,11 Because of the wide differences in duration and content of the primary hospital admission, mortality rates at 30 days are mostly accepted to better represent the safety and effectiveness of hospital management.…”

Section: Introductionmentioning

confidence: 99%

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State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

Ireland¹,

Kelly

Cumming

2016

Aust. Health Review

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Objective. Hospital management of hip fracture varies widely with regard to length of stay, delivery of post-surgical care and costs. The present study compares the association between hospital utilisation and costs and patient outcomes in the six Australian states.Methods. The present study was a retrospective cohort study of linked administrative databases for 2530 Australian veterans and war widows aged 65 years, hospitalised for hip fracture in 2008-09. Department of Veterans' Affairs datasets for hospital episodes, residential aged care admissions and date of death were linked. Patient characteristics, hospital utilisation and process data, rates of mortality and residential care placement and delivery of community services were compared for patients from each of the states.Results. There were no significant differences in fracture incidence, patient demographics or fracture type among the states. Adjusted total mean length of hospital stay ranged from 24.7 days (95% confidence interval (CI) 22.3-27.5 days) to 35.0 days (95% CI 32.6-37.6 days; P < 0.001) and adjusted total hospital cost ranged between A$24 792 (95% CI A$22 191-A$27 700) and A$35 494 (95% CI A$32 853-A$38 343; P < 0.001). Rates of referral to rehabilitation ranged from 31.7% to 50.4% (P = 0.003). At 1 year, there were no significant differences between states for key outcome determinants of mortality (P = 0.71) or for the proportion of patients who retained their independent living status (P = 0.66).Conclusion. Hospital resources for management of hip fracture differ substantially among the Australian states. Key medium-term patient outcomes do not show significant differences. A potential for substantial cost-efficiencies without increased risk to patient welfare is suggested.

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“…For instance, the anomaly in the shapes of the length of stay distribution between intra-and extracapsular fractures, were missed with the Weibull mixture. Actually the anomaly detected by the MLP model was clinically interesting, and a more careful investigation on the issue has been reported elsewhere [48]. In brief, the rehabilitation of patients with extracapsular fractures took longer than in the intracapsular group.…”

Section: Discussionmentioning

confidence: 79%

Analysing the length of care episode after hip fracture: a nonparametric and a parametric Bayesian approach

Riihimäki¹,

Sund

Vehtari³

2009

Health Care Manag Sci

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Effective utilisation of limited resources is a challenge for health care providers. Accurate and relevant information extracted from the length of stay distributions is useful for management purposes. Patient care episodes can be reconstructed from the comprehensive health registers, and in this paper we develop a Bayesian approach to analyse the length of care episode after a fractured hip. We model the large scale data with a flexible nonparametric multilayer perceptron network and with a parametric Weibull mixture model. To assess the performances of the models, we estimate expected utilities using predictive density as a utility measure. Since the model parameters cannot be directly compared, we focus on observables, and estimate the relevances of patient explanatory variables in predicting the length of stay. To demonstrate how the use of the nonparametric flexible model is advantageous for this complex health care data, we also study joint effects of variables in predictions, and visualise nonlinearities and interactions found in the data.

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Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter?

Cited by 33 publications

References 22 publications

Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences

State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes

Analysing the length of care episode after hip fracture: a nonparametric and a parametric Bayesian approach

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