Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study

Nikkel, Lucas E.; Kates, Stephen L.; Schreck, Michael J.; Maceroli, Michael; Mahmood, Bilal; Elfar, John C.

doi:10.1136/bmj.h6246

Cited by 109 publications

(111 citation statements)

References 17 publications

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“…The Nikkel et al result conflicted with two European studies that found longer LOS were associated with decreased risk of mortality [31,32]. Nikkel et al (2015) argue that the contradiction could be due to differences in treatment structures (e.g., time management of hip fracture treatments) or payment systems (e.g. financial considerations in the U.S. that might yield a more rapid discharge), concluding that caution should be used when comparing results from different health care systems [33].…”

Section: Discussionmentioning

confidence: 96%

“…The estimated LOS differences between SNH and NSNH may result in poorer health outcomes for hip fracture patients treated at SNH relative to those treated at NSNH. Nikkel et al [33], using a sample of 169,258 patients from the New York State SPARCS dataset, found that shorter LOS for hip fracture treatments was associated with reduced rates of mortality. The Nikkel et al result conflicted with two European studies that found longer LOS were associated with decreased risk of mortality [31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Nikkel et al (2015) argue that the contradiction could be due to differences in treatment structures (e.g., time management of hip fracture treatments) or payment systems (e.g. financial considerations in the U.S. that might yield a more rapid discharge), concluding that caution should be used when comparing results from different health care systems [33]. The differences in hip fracture treatment LOS found here illustrate that treatment structures and payment systems may not only explain differences across nations, but differences between hospital types within nations as well.…”

Section: Discussionmentioning

confidence: 99%

“…To help isolate the relationship between LOS and SNH, a number of covariates were included in the model. Theory (e.g., injury severity may be associated with LOS) and previous studies examining hip fracture treatment outcomes [7][8][9]33] motivated the covariate selection. Model covariates included: age group (in years: 0-17; 18-29; 30-49; 50-69; 70 years of age and over), gender (female, male), Spanish/Hispanic ethnicity, admission type (emergency/trauma/urgent or other), APR-DRG severity of illness level (minor, moderate, major, extreme), APR-DRG risk of mortality level (minor, moderate, major, extreme), first insurance type (commercial, Medicaid, Medicare, Dual Eligible (Medicaid and Medicare: all of a patients' payment types were used to generate Dual Eligible), self-pay, unknown/other), and discharge disposition (deceased, home, inpatient rehabilitation hospital, other, nursing home/long term care hospital, skilled nursing facility).…”

Section: Methodsmentioning

confidence: 99%

“…Length of stay (LOS) may be considered a process measure; however, Brasel, Lin, Nirula et al argue that focusing on process and structure could result in better outcomes [30]. Furthermore, while two European-based studies did not find a significant relationship between LOS for hip fracture treatments and mortality [31,32], a New York State-based study illustrated that shorter LOS for hip fracture patients were associated with lower mortality risk [33]. LOS for hip fracture treatments may differ between SNH and NSNH due to variation in treatment protocols, post-care management, and other hospital specific factors [8].…”

Section: Introductionmentioning

confidence: 99%

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Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Coffield

Thirunavukkarasu

et al. 2020

BMC Health Serv Res

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Background: Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients' insurance type within each hospital category. Methods: A sample of 48,948 hip fracture patients was extracted from New York State's Statewide Planning and Research Cooperative System (SPARCS), 2014-2016. Using means comparison and X 2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results: LOS was statistically (p ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% (p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion: Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Coffield

Thirunavukkarasu

et al. 2020

BMC Health Serv Res

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Post‐hip‐fracture knee pain in older adults prolongs their hospital stays: A retrospective analysis using propensity score matching

Kaizu,

Miyata,

Arii

2024

Physiotherapy Res Intl

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Background and PurposePost‐hip‐fracture knee pain (PHFKP) occurs in ∼28%–37% of patients and contributes to a prolonged length of hospital stay (LOS). Analyses of LOS prolongation due to PHFKP have been limited to univariate analyses that do not consider important confounding factors. After adjusting for important confounding factors, we investigated whether the presence or absence of PHFKP makes a difference in LOS in patients with hip fractures.MethodsWe conducted a retrospective review of the medical records of patients who had undergone postoperative rehabilitation after surgery for a hip fracture. Demographic and clinical information, discharge parameters, and PHFKP development information were collected from the medical records. Using propensity score matching, we performed a two‐group comparison of LOS, the functional independence measure (FIM) motor score (FIMm), FIMm gain, and FIMm effectiveness in patients with and without PHFKP. Six variables were included in the calculation of propensity scores: age, sex, body mass index, fracture type, American Society of Anesthesiologists physical status, and independence in activities of daily living at discharge. One‐way analysis of variance was used to examine the details of the relationships between LOS and (i) the time of PHFKP development and (ii) pain intensity.ResultsWe analyzed the cases of 261 patients, of whom 87 (33.3%) developed PHFKP. In propensity score matching, 80 patients were each matched to a patient in the PHFKP or non‐PHFKP group. After propensity score matching, a between‐group comparison revealed that the PHFKP group had a longer LOS (+11 days) than the non‐PHFKP group, and there were no differences in FIMm gain or FIMm effectiveness. The timing of PHFKP development and pain intensity were not related to the LOS.DiscussionEven after adjusting for confounders, the development of PHFKP was found to prolong LOS. Clinicians should be aware of possible LOS prolongation in hip fracture patients with PHFKP.

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Epidemiology of Fragility Fractures and Social Impact

Veronese¹,

Kolk

Maggi

2020

Practical Issues in Geriatrics

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Hip fracture is an important and debilitating condition in older people, especially in women. The epidemiological data vary between countries, but it is globally estimated that hip fractures currently affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually decreasing in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society. At the same time, increasing attention is given to other osteoporotic fractures, such as vertebral ones, that are associated with negative health outcomes and enormous costs. In this chapter, we describe the most recent epidemiological data regarding hip and other osteoporotic fractures, with special attention to the well-known risk factors and conditions that seem relevant for determining fractures in older people. A specific part is dedicated to the social costs due to fractures. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new comorbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater.

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Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study

Abstract: Study question Can the length of hospital stay for hip fracture affect a patient's risk of death 30 days after discharge?

Cited by 109 publications

References 17 publications

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Post‐hip‐fracture knee pain in older adults prolongs their hospital stays: A retrospective analysis using propensity score matching

Epidemiology of Fragility Fractures and Social Impact

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