Discharge destination following hip fracture: comparative effectiveness and cost analyses

Pitzul, Kristen B.; Wodchis, Walter P.; Kreder, Hans J.; Carter, Michael; Jaglal, Susan

doi:10.1007/s11657-017-0382-8

Cited by 25 publications

(19 citation statements)

References 30 publications

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“…Pitzul et al's recent work raises concern regarding our findings as patients in Ontario who received post-acute inpatient rehabilitation had lower mortality and re-admissions within the first year after hip fracture than those who were discharged directly to the community [32]. A recent systematic review also identified that both patient and facility factors lead to increased readmissions after hip fracture [30].…”

Section: Discussionmentioning

confidence: 79%

“…In Ontario, Pitzul et al (2016) identified 49 unique post-discharge pathways utilized following hip fracture with significant regional and hospital variation [31]. Although inpatient rehabilitation was associated with higher initial costs, patients who were discharged to the community were more likely to be re-admitted or die within one-year of hip fracture than patients discharged to inpatient rehabilitation [32]. Others have reported similar findings in both the USA and internationally; rehabilitation may be associated with increased costs, but often leads to improved patient outcomes [19,[33][34][35].…”

Section: Introductionmentioning

confidence: 99%

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Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

et al. 2019

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

et al. 2019

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“…Our results suggest that a more stringent overlapping surgery policy did not lead to cost savings in our cohort, and overlapping surgery was not associated with higher or lower costs in and of itself. The variables that did appear to lead to higher hospitalization costs were largely unsurprising-complications, 5,12 emergency surgery, 11 operating room time, 15 surgery type, 6 inability to discharge home, 17 higher ASA class, 19 and tobacco use 10,16 -and have all previously been shown to be significantly associated with hospital costs. Our finding that preoperative steroid use was associated with lower costs was somewhat surprising, although some evidence suggests that such use may reduce length of stay in patients undergoing crani- otomy for tumor, which may partially explain this association.…”

Section: Discussionmentioning

confidence: 99%

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Guan¹,

Karsy²,

Brock³

et al. 2019

Journal of Neurosurgery

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OBJECTIVEOverlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.METHODSThe authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.RESULTSA total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.CONCLUSIONSA more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.

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“…a topic for debate. Similar patients with hip fracture discharged to different postacute settings (i.e., home-based rehabilitation, post-acute care facilities and inpatient rehabilitation) seem to have different outcomes [80,81]. The quality of care of post-acute and rehabilitation facilities is another variable that may affect long-term outcomes.…”

Section: Gastrointestinal Complicationsmentioning

confidence: 99%

Post-operative Management

Pioli

Bendini

Pignedoli

2020

Practical Issues in Geriatrics

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The management of hip fracture in older people in the post-operative setting requires a multidisciplinary approach and geriatric competencies. The main goals of the post-operative stage are early mobilisation and prevention of complications. To achieve the goal of early mobilisation a stable surgical repair is essential, allowing the patient to bear weight as tolerated, as well as effective pain control and fluid management protocols, ensuring an adequate volume and avoiding orthostatic hypotension. Due to the age-related decline of the physiological reserve and function across multi-organ systems, patients with hip fracture are at risk of multiple complications. Almost every organ is vulnerable, although cognitive dysfunction, cardiac complications and infections are the most frequent and clinically significant. In most common conditions a systematic approach in the management of hip fracture, through a checklist for each professional and shared protocols, is an established method to improve the quality of the intervention and reduce post-operative complications. The vulnerability to complications of older patients with hip fractures may last for several days after surgical repair. However, this group of patients is at high risk of deconditioning in hospital and thus early discharge-planning based on discharge needs is a crucial component in the management of the acute episode.

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Discharge destination following hip fracture: comparative effectiveness and cost analyses

Cited by 25 publications

References 30 publications

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

Post-operative Management

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