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Hospital mortality after hip fracture surgery in relation to length of stay by care delivery factors: A database study.

Abstract Two hypotheses were offered for the effect of shorter hospital stays on mortality after hip fracture surgery: worsening the quality of care and shifting death occurrence to postacute settings.We tested whether the risk of hospital death after hip fracture surgery differed across years when postoperative stays shortened, and whether care factors moderated the association.Analysis of acute hospital discharge abstracts for subgroups defined by hospital type, bed capacity, surgical volume, and admission time.153,917 patients 65 years or older surgically treated for first hip fracture.Risk of hospital death.We found a decrease in the 30-day risk of hospital death from 7.0% (95%CI: 6.6-7.5) in 2004 to 5.4% (95%CI: 5.0-5.7) in 2012, with an adjusted odds ratio [OR] 0.71 (95%CI: 0.63-0.80). In subgroup analysis, only large community hospitals showed the reduction of ORs by calendar year. No trend was observed in teaching and medium community hospitals. By 2012, the risk of death in large higher volume community hospitals was 34% lower for weekend admissions, OR = 0.66 (95%CI: 0.46-0.95) and 39% lower for weekday admissions, OR = 0.61 (95%CI: 0.40-0.91), compared to 2004. In large lower volume community hospitals, the 2012 risk was 56% lower for weekend admissions, OR = 0.44 (95%CI: 0.26-0.75), compared to 2004.The risk of hospital death after hip fracture surgery decreased only in large community hospitals, despite universal shortening of hospital stays. This supports the concern of worsening the quality of hip fracture care due to shorter stays.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422882
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - Hospital mortality after hip fracture surgery in relation to length of stay by
      care delivery factors: A database study.
PG  - e6683
LID - 10.1097/MD.0000000000006683 [doi]
AB  - Two hypotheses were offered for the effect of shorter hospital stays on mortality
      after hip fracture surgery: worsening the quality of care and shifting death
      occurrence to postacute settings.We tested whether the risk of hospital death
      after hip fracture surgery differed across years when postoperative stays
      shortened, and whether care factors moderated the association.Analysis of acute
      hospital discharge abstracts for subgroups defined by hospital type, bed
      capacity, surgical volume, and admission time.153,917 patients 65 years or older 
      surgically treated for first hip fracture.Risk of hospital death.We found a
      decrease in the 30-day risk of hospital death from 7.0% (95%CI: 6.6-7.5) in 2004 
      to 5.4% (95%CI: 5.0-5.7) in 2012, with an adjusted odds ratio [OR] 0.71 (95%CI:
      0.63-0.80). In subgroup analysis, only large community hospitals showed the
      reduction of ORs by calendar year. No trend was observed in teaching and medium
      community hospitals. By 2012, the risk of death in large higher volume community 
      hospitals was 34% lower for weekend admissions, OR = 0.66 (95%CI: 0.46-0.95) and 
      39% lower for weekday admissions, OR = 0.61 (95%CI: 0.40-0.91), compared to 2004.
      In large lower volume community hospitals, the 2012 risk was 56% lower for
      weekend admissions, OR = 0.44 (95%CI: 0.26-0.75), compared to 2004.The risk of
      hospital death after hip fracture surgery decreased only in large community
      hospitals, despite universal shortening of hospital stays. This supports the
      concern of worsening the quality of hip fracture care due to shorter stays.
FAU - Sobolev, Boris
AU  - Sobolev B
AD  - aSchool of Population and Public Health, University of British Columbia,
      Vancouver, Canada bDepartment of Orthopedics, University of British Columbia
      cDivision of Orthopaedic Surgery and Center for Healthcare Innovation, University
      of Manitoba, Winnipeg dDepartments of Physical Therapy and Division of
      Orthopaedic Surgery, University of Alberta, Edmonton eDepartment of Medicine,
      McGill University, Montreal fDivision of Orthopaedic Surgery, Dalhousie
      University, Halifax gDepartment of Anesthesiology, Pharmacology & Therapeutics,
      University of British Columbia, Vancouver hDepartment of Physical Therapy,
      University of Toronto, Toronto iCentre for Clinical Epidemiology and Evaluation, 
      Vancouver Coastal Health Research Institute, Vancouver, Canada.
FAU - Guy, Pierre
AU  - Guy P
FAU - Sheehan, Katie J
AU  - Sheehan KJ
FAU - Bohm, Eric
AU  - Bohm E
FAU - Beaupre, Lauren
AU  - Beaupre L
FAU - Morin, Suzanne N
AU  - Morin SN
FAU - Sutherland, Jason M
AU  - Sutherland JM
FAU - Dunbar, Michael
AU  - Dunbar M
FAU - Griesdale, Donald
AU  - Griesdale D
FAU - Jaglal, Susan
AU  - Jaglal S
FAU - Kuramoto, Lisa
AU  - Kuramoto L
CN  - Canadian Collaborative Study on Hip Fractures
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006683 [doi]
AID - 00005792-201704210-00063 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6683. doi: 10.1097/MD.0000000000006683.

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