Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery

Document Type: RESEARCH PAPER

Authors

1 Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Texas, USA

2 Department of Orthopaedic Surgery, JPS Health Network, TX, USA

3 Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Heidelberglaan, Utrecht, The Netherlands

4 Orthopaedic Clinical Nurse Specialist, Texas Health Harris Methodist Hospital Fort Worth, TX, USA

5 Department of Orthopaedic Surgery, Acclaim Physician group, Ben Hogan Center, TX, USA

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 can
lower reimbursement. A better understanding of the patient and treatment characteristics associated with readmission
may help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay is
not associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of a
proximal 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, admitted
for treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regression
models 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 a
lower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASA
class 3, 4 and 5.
Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmission
within one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify and
disseminate best practices might reduce readmission rates.
Level of evidence: III

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