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

Retrospective cohort study

Lucas Nikkel, Stephen L. Kates, Michael Schreck, Michael Maceroli, Bilal Mahmood, John Elfar

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Study question Can the length of hospital stay for hip fracture affect a patient's risk of death 30 days after discharge? Methods In a retrospective cohort study, population based registry data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used to investigate 188 208 patients admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients were aged 50 years and older, and received surgical or non-surgical treatment. The main outcome measure was the mortality rate at 30 days after hospital discharge. Study answer and limitations Hospital stays of 11-14 days for hip fracture were associated with a 32% increased odds of death 30 days after discharge, compared with stays lasting one to five days (odds ratio 1.32 (95% confidence interval 1.19 to 1.47)). These odds increased to 103% for stays longer than 14 days (2.03 (1.84 to 2.24)). Other risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management. The 30 day mortality rate after discharge was 4.5% for surgically treated patients and 10.7% for non-surgically treated patients. These findings might not be generalizable to populations in other US states or in other countries. The administrative claims data used could have been incomplete or include inaccurate coding of diagnoses and comorbid conditions. The database also did not include patient socioeconomic status, which could affect access to care to a greater extent in New York state than in European countries. Specific cause of death was not available because few autopsies are performed in this population. What this study adds By contrast with recent findings in Sweden, decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality in a US cohort in New York state. This could reflect critical system differences in the treatment of hip fractures between Europe and the USA.

Original languageEnglish (US)
Article numberA3718
JournalBMJ (Online)
Volume351
DOIs
StatePublished - Dec 10 2015

Fingerprint

Hip Fractures
Length of Stay
Cohort Studies
Retrospective Studies
Mortality
Population
Hospices
Sweden
Social Class
Registries
Cause of Death
Autopsy
Odds Ratio
Outcome Assessment (Health Care)
Databases
Confidence Intervals
Therapeutics
Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{7861b8dafe4c43ce8461699f2e824892,
title = "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? Methods In a retrospective cohort study, population based registry data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used to investigate 188 208 patients admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients were aged 50 years and older, and received surgical or non-surgical treatment. The main outcome measure was the mortality rate at 30 days after hospital discharge. Study answer and limitations Hospital stays of 11-14 days for hip fracture were associated with a 32{\%} increased odds of death 30 days after discharge, compared with stays lasting one to five days (odds ratio 1.32 (95{\%} confidence interval 1.19 to 1.47)). These odds increased to 103{\%} for stays longer than 14 days (2.03 (1.84 to 2.24)). Other risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management. The 30 day mortality rate after discharge was 4.5{\%} for surgically treated patients and 10.7{\%} for non-surgically treated patients. These findings might not be generalizable to populations in other US states or in other countries. The administrative claims data used could have been incomplete or include inaccurate coding of diagnoses and comorbid conditions. The database also did not include patient socioeconomic status, which could affect access to care to a greater extent in New York state than in European countries. Specific cause of death was not available because few autopsies are performed in this population. What this study adds By contrast with recent findings in Sweden, decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality in a US cohort in New York state. This could reflect critical system differences in the treatment of hip fractures between Europe and the USA.",
author = "Lucas Nikkel and Kates, {Stephen L.} and Michael Schreck and Michael Maceroli and Bilal Mahmood and John Elfar",
year = "2015",
month = "12",
day = "10",
doi = "10.1136/bmj.h6246",
language = "English (US)",
volume = "351",
journal = "The BMJ",
issn = "0267-0623",
publisher = "BMJ Publishing Group",

}

Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state : Retrospective cohort study. / Nikkel, Lucas; Kates, Stephen L.; Schreck, Michael; Maceroli, Michael; Mahmood, Bilal; Elfar, John.

In: BMJ (Online), Vol. 351, A3718, 10.12.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state

T2 - Retrospective cohort study

AU - Nikkel, Lucas

AU - Kates, Stephen L.

AU - Schreck, Michael

AU - Maceroli, Michael

AU - Mahmood, Bilal

AU - Elfar, John

PY - 2015/12/10

Y1 - 2015/12/10

N2 - Study question Can the length of hospital stay for hip fracture affect a patient's risk of death 30 days after discharge? Methods In a retrospective cohort study, population based registry data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used to investigate 188 208 patients admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients were aged 50 years and older, and received surgical or non-surgical treatment. The main outcome measure was the mortality rate at 30 days after hospital discharge. Study answer and limitations Hospital stays of 11-14 days for hip fracture were associated with a 32% increased odds of death 30 days after discharge, compared with stays lasting one to five days (odds ratio 1.32 (95% confidence interval 1.19 to 1.47)). These odds increased to 103% for stays longer than 14 days (2.03 (1.84 to 2.24)). Other risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management. The 30 day mortality rate after discharge was 4.5% for surgically treated patients and 10.7% for non-surgically treated patients. These findings might not be generalizable to populations in other US states or in other countries. The administrative claims data used could have been incomplete or include inaccurate coding of diagnoses and comorbid conditions. The database also did not include patient socioeconomic status, which could affect access to care to a greater extent in New York state than in European countries. Specific cause of death was not available because few autopsies are performed in this population. What this study adds By contrast with recent findings in Sweden, decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality in a US cohort in New York state. This could reflect critical system differences in the treatment of hip fractures between Europe and the USA.

AB - Study question Can the length of hospital stay for hip fracture affect a patient's risk of death 30 days after discharge? Methods In a retrospective cohort study, population based registry data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used to investigate 188 208 patients admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients were aged 50 years and older, and received surgical or non-surgical treatment. The main outcome measure was the mortality rate at 30 days after hospital discharge. Study answer and limitations Hospital stays of 11-14 days for hip fracture were associated with a 32% increased odds of death 30 days after discharge, compared with stays lasting one to five days (odds ratio 1.32 (95% confidence interval 1.19 to 1.47)). These odds increased to 103% for stays longer than 14 days (2.03 (1.84 to 2.24)). Other risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management. The 30 day mortality rate after discharge was 4.5% for surgically treated patients and 10.7% for non-surgically treated patients. These findings might not be generalizable to populations in other US states or in other countries. The administrative claims data used could have been incomplete or include inaccurate coding of diagnoses and comorbid conditions. The database also did not include patient socioeconomic status, which could affect access to care to a greater extent in New York state than in European countries. Specific cause of death was not available because few autopsies are performed in this population. What this study adds By contrast with recent findings in Sweden, decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality in a US cohort in New York state. This could reflect critical system differences in the treatment of hip fractures between Europe and the USA.

UR - http://www.scopus.com/inward/record.url?scp=84959356789&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959356789&partnerID=8YFLogxK

U2 - 10.1136/bmj.h6246

DO - 10.1136/bmj.h6246

M3 - Article

VL - 351

JO - The BMJ

JF - The BMJ

SN - 0267-0623

M1 - A3718

ER -