Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay

Teixeira, A.; Trinquart, Ludovic; Raphaël, M.; Bastianic, T.; Châtellier, Gilles; Holstein, J.

doi:10.1093/ageing/afp124

Cited by 38 publications

(55 citation statements)

References 22 publications

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“…Readmissions defined as admissions for hip fracture within 90 days after discharge following the index admission were likely due to medical postoperative complications and were not included in the analysis [21]. Readmissions defined as admissions for hip fracture beyond 90 days were likely due to revision surgery or for a subsequent hip fracture [21]. Readmissions for revision surgery are identified by ICD-9-CM diagnostic codes, e.g.…”

Section: Data Sourcesmentioning

confidence: 99%

Risk of second hip fracture persists for years after initial trauma

Sobolev

Kuramoto

Guy

2015

Bone

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Section: Data Sourcesmentioning

confidence: 99%

Risk of second hip fracture persists for years after initial trauma

Sobolev

Kuramoto

Guy

2015

Bone

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“…However, participants with a femoral fracture as discharge diagnosis of their first hospitalization were excluded because it is known that readmissions with a related diagnosis to the index stay are increased during the first months. (4,5) A second reason was to avoid double coding of the same fracture (eg, readmission due to complications or transfers between hospitals). For the same reason the observation time of the participants was restricted up to a first femoral fracture and following hospitalizations were no longer considered.…”

Section: Statisticsmentioning

confidence: 99%

Femoral fracture rates after discharge from the hospital to the community

Rapp

Cameron

Becker

et al. 2012

Journal of Bone and Mineral Research

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Previous studies found that the risk of a femoral fracture in residents newly admitted to nursing homes was highest during the first months after admission and declined thereafter. Many nursing home admissions are preceded by a hospitalization. Therefore, the present study aimed to analyze if a similar risk pattern of fall-related fractures could also be observed in community-dwelling people at home after discharge from the hospital. Routine data of more than 690,000 German people aged 65 years and older with more than 2 million hospital discharges were used to calculate fracture rates in the first 6 months after hospitalization, for people discharged to live in the community. Incidence rates of femoral fractures as a function of time since discharge from hospital were analyzed. Analyses were stratified by sex, age, the need for care, and diagnostic groups. For femoral fractures the incidence was highest during the first months after discharge and declined thereafter. This pattern was observed in women and men, in different age-groups, in different diagnostic groups, and in people with and without the need for care. For example, rates for femoral fractures in women declined from 17.4 to 11.0 per 1000 person years over the first 6 months after admission, and in men over the same time period from 8.2 to 4.5 per 1000 personyears, respectively. We conclude that the first weeks at home after discharge from the hospital are associated with an increased risk for femoral fractures. ß

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“…There is a relationship between comorbidities and readmissions after orthopaedic trauma surgery [23,35]. In orthopaedic surgery, comorbidities have been identified as predictors of mortality after arthroplasty, trauma surgery, and oncologic surgery [4,9,18,20,21,25,27,36].…”

Section: Introductionmentioning

confidence: 99%

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

Voskuijl

Hageman

Ring

2014

Clinical Orthopaedics &Amp; Related Research

178

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Background The Charlson Comorbidity Index (CCI) originally was developed to predict mortality within 1 year of hospital admission in patients without trauma. As it includes factors associated with medical and surgical complexities, it also may be useful as a predictive tool for hospital readmission after orthopaedic surgery, but to our knowledge, this has not been studied. Questions/purposes We asked whether an increased score on the CCI was associated with (1) readmission, (2) an increased risk of surgical site infection or other adverse events, (3) transfusion risk, or (4) mortality after orthopaedic surgery. Methods A total of 30,129 orthopaedic surgeries performed between 2008 and 2011 without any orthopaedic surgery in the preceding 30 days were analyzed. International Classification of Diseases, 9 th Revision codes were used to identify diagnoses, procedures, surgery-related adverse events, surgical site infection, and comorbidities as listed in the updated and reweighted CCI. A total of 913 patients (3.0%) were readmitted within 30 days after discharge; in 393 (1.4%) patients adverse events occurred; 417 patients (1.4%) had a surgical site infection develop; 211 (0.7%) needed transfusions, and 56 (0.2%) died within 30 days after surgery. Ordinary least squares regression analyses were used to determine whether the CCI was associated with these outcomes. Results The CCI accounted for 10% of the variation in readmissions. Every point increase in CCI score added an additional 0.45% risk in readmission for patients undergoing arthroplasty, 0.63% for patients undergoing trauma surgery, and 0.9% risk for patients undergoing spine surgery (all p \ 0.01). The CCI was not associated with surgical site infection or other adverse events, but accounted for 8% of the variation in transfusion rate and 10% of the variation in mortality within 30 days of surgery. Conclusions The CCI can be used to estimate the risk of readmission after arthroplasty, hand and upper extremity surgery, spine surgery, and trauma surgery. It also can be used to estimate the risk of transfusion after arthroplasty, spine, trauma, and oncologic orthopaedic surgery and the risk of mortality after shoulder, trauma, and oncologic orthopaedic surgery.

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Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay

Cited by 38 publications

References 22 publications

Risk of second hip fracture persists for years after initial trauma

Risk of second hip fracture persists for years after initial trauma

Femoral fracture rates after discharge from the hospital to the community

Higher Charlson Comorbidity Index Scores are Associated With Readmission After Orthopaedic Surgery

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