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

Document Type : RESEARCH PAPER


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


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


Main Subjects

1. Kates SL, Shields E, Behrend C, Noyes KK. Financial
implications of hospital readmission after hip fracture.
Geriatr Orthop Surg Rehabil. 2015; 6(3):140-6.
2. Martinez-Reig M, Ahmad L, Duque G. The
orthogeriatrics model of care: systematic review of
predictors of institutionalization and mortality in posthip
fracture patients and evidence for interventions. J
Am Med Dir Assoc. 2012; 13(9):770-7.
3. Rapp K, Becker C, Lamb SE, Klenk J. Hip fractures
in institutionalized elderly people: incidence rates
and excess mortality. J Bone Miner Res. 2008;
4. Axon RN, Williams MV. Hospital readmission as an
accountability measure. JAMA. 2011; 305(5):504-5.
5. Ali AM, Gibbons CE. Predictors of 30-day hospital
readmission after hip fracture: a systematic review.
Injury. 2017; 48(2):243-52.
6. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey
W, DeCoster TA, et al. Fracture and dislocation
classification compendium - 2007: Orthopaedic
Trauma Association classification, database and
outcomes committee. J Orthop Trauma. 2007; 21(10
7. Basques BA, Bohl DD, Golinvaux NS, Leslie MP,
Baumgaertner MR, Grauer JN. Postoperative length
of stay and 30-day readmission after geriatric hip
fracture: an analysis of 8434 patients. J Orthop
Trauma. 2015; 29(3):e115-20.
8. Treskes K, Voeten SC, Tol MC, Zuidema WP, Vermeulen
J, Goslings JC, et al. Trauma surgery by general
surgeons: still an option for proximal femoral
fractures? Injury. 2017; 48(2):339-44.
9. Clement RC, Strassle PD, Ostrum RF. Should all
orthopaedists perform hemiarthroplasty for femoral
neck fractures? a volume-outcome analysis. J Orthop
Trauma. 2018; 32(7):354-60.
10. Malik AT, Panni UY, Masri BA, Noordin S. The impact of
surgeon volume and hospital volume on postoperative
mortality and morbidity after hip fractures: a
systematic review. Int J Surg. 2018; 54(Pt B):316-27.
11. L Riska BS, Forsen L, Omsland TK, Søgaard AJ, Meyer
HE, Holvik K. Does the association of comorbidity
with 1-year mortality after hip fracture differ
according to gender? The norwegian epidemiologic
osteoporosis studies (NOREPOS). J Am Geriatr Soc.
2018; 66(3):553-8.
12. Forsen L, Sogaard AJ, Meyer HE, Edna T, Kopjar B.
Survival after hip fracture: short- and long-term excess
mortality according to age and gender. Osteoporos
Int. 1999; 10(1):73-8.