Trauma
Tom J. Crijns; Tyler Caton; Teun Teunis; Jacob T. Davis; Kindra McWilliam-Ross; David Ring; Hugo B. Sanchez
Abstract
Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment ...
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Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment characteristics associated with readmissionmay help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay isnot associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of aproximal femur fracture, accounting for discharge destination and other factors.Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admittedfor treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regressionmodels were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score(ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with alower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASAclass 3, 4 and 5.Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmissionwithin one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify anddisseminate best practices might reduce readmission rates.Level of evidence: III
Hip
David N. Bernstein; Jacob T. Davis; Carson Fairbanks; Kindra McWilliam-Ross; David Ring; Hugo B. Sanchez
Abstract
Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoralneck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years,is there a difference in quantitative ultrasound of the heel (QUS) t-score ...
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Background: A better understanding of how bone mineral density and vitamin D levels are associated with femoralneck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years,is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoralneck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years,is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of theintertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?Methods: In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fracturesbetween December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management fora hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture typeusing patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptivestatistics, bivariate analyses and multivariable regression were performed.Results: Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochantericfemur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D leveland either fracture type. There was no association between vitamin D level and bone mineral density.Conclusion: Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochantericregion than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes theimportance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.Level of evidence: III