Causes and predictors of early re-admission after surgery for a fracture of the hip

Abstract

The aim of this study was to examine the rates and potential risk factors for 28-day re-admission following a fracture of the hip at a high-volume tertiary care hospital. We retrospectively reviewed 467 consecutive patients with a fracture of the hip treated in the course of one year. Causes and risk factors for unplanned 28-day re-admissions were examined using univariate and multivariate analysis, including the difference in one-year mortality. A total of 55 patients (11.8%) were re-admitted within 28 days of discharge. The most common causes were pneumonia in 15 patients (27.3%), dehydration and renal dysfunction in ten (18.2%) and deteriorating mobility in ten (18.2%). A moderate correlation was found between chest infection during the initial admission and subsequent re-admission with pneumonia (r = 0.44, p < 0.001). A significantly higher mortality rate at one year was seen in the re-admission group (41.8% (23 of 55) vs. 18.7% (77 of 412), p < 0.001). Logistic regression analysis identified advancing age, admission source, and the comorbidities of diabetes and neurological disorders as the strongest predictors for re-admission. Early re-admission following hip fracture surgery is predominantly due to medical causes and is associated with higher one-year mortality. The risk factors for re-admission can have implications for performance-based pay initiatives in the NHS. Multidisciplinary management in reducing post-operative active clinical problems may reduce early re-admission.

Diabetes Confers Little to No Increased Risk of Postoperative Complications After Hip Fracture Surgery in Geriatric Patients

“…The only differences were an increased risk of pressure ulcers and increased congestive heart failure and renal failure at 24 months followup, comparisons that were unavailable to us owing to specifics of the ACS-NSQIP 1 database. Finally, the findings of our study are in contrast to those of some studies that have associated diabetes with an increased risk of renal complications, readmission, and mortality after hip fracture surgery [1,14,17]. However, as an example, the study that identified an increased risk of kidney disease in patients with diabetes used an increase of 0.3 mg/dL in creatinine as criteria for postoperative kidney disease.…”

“…It is evident that the definitions of each variable are divergent among studies and may account for the differences in findings. Similarly, the study that determined an increase in readmission rate associated with patients with diabetes was complicated by dissimilar study groups for comparison [14]. The group that was readmitted had a statistically significant difference in the procedure performed and the rate of patients discharged to a skilled nursing facility.…”

“…Previous studies evaluating diabetes and operative stabilization of hip fractures have shown an increased risk of postoperative cardiac complications [10,22], renal dysfunction [10,17], urinary retention [1], extended length of hospital stay [22], and hospital readmission within 28 days [14]. Although all valuable contributions, many of these investigations were limited by small sample sizes, restriction to a single-hospital system, or lack of postdischarge followup.…”

Predictive factors for early hospital readmission and one year mortality in elder patients following surgical treatment of a hip fracture

“…[6] In their study, which aimed to identify causes and associated risk factors for admission, Buecking et al also reported that the most frequent reasons were non-surgical, such as respiratory failure, cardiovascular diseases, and acute renal failure. [17] Surgery-related factors accounted for 31.7% of our patients who were readmitted within the first 30 days of hospital discharge.…”

“…[5] However, an increased risk of developing perioperative and/or postoperative infective, cardiac, respiratory, genitourinary, and gastrointestinal complications causing significant rates of mortality and morbidity has been reported for such patients. [6] In-hospital mortality rates may rise to 10%. [7,8] Further-…”