Readmission Rates After Hip Fracture

Are There Prefracture Warning Signs for Patients Most at Risk of Readmission?

Jake X. Checketts, DO; Qingqing Dai, BS; Lan Zhu, PhD; Zhuqi Miao, PhD; Scott Shepherd, DO; Brent L. Norris, MD

Disclosures

J Am Acad Orthop Surg. 2020;28(24):1017-1026. 

In This Article

Abstract and Introduction

Abstract

Background: The purpose of this study was to evaluate known and yet unknown risk factors associated with readmission to the hospital within 30 days after hip fracture.

Methods: In this study, we used the Cerner Health Facts Electronic Health Record database data from January to August 2015. The univariate association of each variable (discharge location, demographic details, and comorbidities) against the 30-day readmission status was evaluated using the Chi-square test or the Fisher exact test. The significant variables (P < 0.05) obtained by the univariate analysis were used to build the multivariate logistic regression model to evaluate the multivariate associations of the variables.

Results: Thirty-four thousand seven hundred ninety index admissions of 33,740 unique patients were included in the study cohort. The overall 30-day readmission rate for patients with hip fractures was 10.7%. We demonstrated a new variable not discussed in previous articles on this topic: patients with previous inpatient/emergency visits within the past year were more likely to be readmitted within 30 days after the hip fracture surgery (P < 0.001).

Conclusion: For patients with hip fractures, particular efforts should be taken to optimize outcomes in those with recent hospitalizations and/or discharge to a location other than home.

Introduction

Hip fractures are and will continue to be a major healthcare burden for the United States (US). As the cohort gets older, the number of hip fractures continues to increase. Each year, over 300,000 elderly people are hospitalized for hip fractures.[1] Of these hip fractures more than 95% are caused by falling,[2] with the direction of the fall being primarily sideways.[3] Women experience three-quarters of all hip fractures and are more likely to develop osteoporosis,[2] a disease that weakens bones and makes them more likely to break. Finally, the chances of breaking your hip go up as you get older.[3] Therefore, hip fractures are and should be a major healthcare issue that requires continued studies to best determine preventive, interventional, and posttreatment protocols that can maximize outcomes and limit complications (and indirectly lower potentially unnecessary additional healthcare spending). The goal of hip fracture treatment is, and should remain, to return the patient to their preinjury level of function while managing pre-existing chronic conditions (such as diabetes mellitus, hypertension, chronic renal insufficiency, and osteoporosis).

With the passage of the Affordable Care Act in 2009, Medicare is fining hospitals for patients who get readmitted within 30 days for myocardial infarction, heart failure, pneumonia, coronary artery bypass grafting, and elective total knee and hip arthroplasties.[4] It has been suggested that surveillance will expand to include fracture-related readmissions because Medicare is considering the implementation of quality improvement programs that may include 30-day hip fracture readmission.[5] Hospitals may soon have the additional burden of being fined if patients are readmitted within 30 days after the hip fracture admission. For this reason, many researchers are evaluating the hip fracture readmission rates looking specifically for risk factors that can help predict patients at the highest risk of readmission.[6] If the factors are identified, better treatment strategies during a patient's admission may be available. Furthermore, doing so will also optimize the placement of patients into the most appropriate postoperative environment to best facilitate recovery.

Our study examines a very large, multicenter, longitudinal database to evaluate readmission rates after hip fractures. The purpose of this study was to evaluate known and yet unknown risk factors associated with readmission to the hospital within 30 days after hip fracture. By examining the utilization of the hospital (via admission to the hospital or by ED visit) before the index hip fracture, we might be able to identify a more "fragile" patient who could be at a very high risk of readmission within 30 days after the hip fracture. We hypothesize that patients having been admitted to the hospital two or more times in the year before the index hip fracture are at a higher risk of readmission after hip fracture. We think this to be the case because multiple previous hospitalizations would indicate a more fragile patient, thus requiring more forethought on the part of the medical team in optimizing outcomes and preventing rehospitalization or reoperation.

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