Readmission Within 30 Days of Discharge After Hip Fracture Care

Abstract

The Affordable Care Act currently requires hospitals to report 30-day readmission rates for certain medical conditions. It has been suggested that surveillance will expand to include hip and knee surgery-related readmissions in the future. To ensure quality of care and avoid penalties, readmissions related to hip fractures require further investigation. The goal of this study was to evaluate factors associated with 30-day hospital readmission after hip fracture at a level I trauma center. This retrospective cohort study included 1486 patients who were 65 years or older and had a surgical procedure performed to treat a femoral neck, intertrochanteric, and/or subtrochanteric hip fracture during an 8-year period. Analysis of these patients showed a 30-day readmission rate of 9.35% (n=139). Patients in the readmission group had a significantly higher rate of pre-existing diabetes and pulmonary disease and a longer initial hospital length of stay. Readmissions were primarily the result of medical complications, with only one-fourth occurring secondary to orthopedic surgical failure. Pre-existing pulmonary disease (odds ratio [OR], 1.885; 95% confidence interval [CI], 1.305–2.724), initial hospitalization of 8 days or longer (OR, 1.853; 95% CI, 1.223–2.807), and discharge to a skilled nursing facility (OR, 1.586; 95% CI, 1.043–2.413) were determined to be predictors of readmission. Accordingly, patient management should be consistently geared toward optimizing chronic disease states while concomitantly working to minimize the duration of initial hospitalization and decrease readmission rates.

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

“…According to different studies, age, time to surgery, male gender, BMI, functional dependence status, ASA grade, ICU stay, and length of initial hospitalization have been discussed in direct relation to readmission rates by several authors. [5,17,18] Eschbach et al reported that patients of advanced age with hip-related fractures showed neither a prolonged in-hospital nor ICU stay, and there was no significant relation between advanced age and the number and type of complications. [19] In the current study, univariate analysis of these factors revealed that age, pre-fracture mobility dependence, ASA grade ≥3, and ICU stay were significant patient-related risk factors.…”

“…[5] The burden of comorbidities has been demonstrated as significantly associated with a higher risk of readmission. [18] Active clinical problems at the time of discharge may also play a leading role as the potential source of complications and readmission.…”

“…[5] Respiratory tract infections, particularly pneumonia, have been emphasized by different authors as the leading cause in the literature. [5,15,16,20] Pneumonia was also the most common reason in the current study, accounting for 15.9% of complications leading to readmission, followed by cardiovascular events, respiratory distress, and urinary tract infection. No significant correlation between a pre-existing history of chronic pulmonary disease and subsequent readmission due to pneumonia was detected.…”

“…[3,4] The main purpose of surgical interventions in elderly patients with hip fracture is to return them to a preinjury level of daily living activities and social functioning. [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%.…”

Multimodal Analgesia in the Hip Fracture Patient

“…Moreover, the frequency of complications and readmissions seems to be higher when patients are discharged to a skilled nursing facility. 6 And finally, of course, the potential for a wide range of undesirable and potentially dangerous adverse events using opioid drugs is widely recognized.…”