Can We Predict 30-Day Readmission After Hip Fracture?

IF 1.6 3区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Trauma Pub Date : 2025-04-01 DOI:10.1097/BOT.0000000000002946
Christopher J Pettit, Carolyn F Herbosa, Abhishek Ganta, Steven Rivero, Nirmal Tejwani, Philipp Leucht, Sanjit R Konda, Kenneth A Egol
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Abstract

Objectives: To determine the most common reason for 30-day readmission after hospitalization for hip fractures.

Methods:

Design: A retrospective review.

Setting: Single academic medical center that includes a Level 1 trauma center.

Patient selection criteria: Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients who died during their initial admission were excluded.

Outcome measures and comparisons: Patient demographics, hospital quality measures, outcomes, and readmission within 30 days after discharge for each patient were reviewed. Thirty-day readmission reason was recorded and correlation analysis was performed.

Results: A total of 3032 patients were identified with a mean age of 82.1 years and 70.5% of patients being women. The 30-day readmission cohort was 2.6 years older ( P < 0.001) and 8.8% more male patients ( P = 0.027), had 0.5 higher Charleston comorbidity index ( P < 0.001), 0.3 higher American Society of Anesthesiologists class ( P < 0.001), and were 9.2% less independent at the time of admission ( P = 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared with closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, P < 0.001). Those readmitted by 30 days developed more major (16.7% vs. 8.0%; P < 0.001) and minor (50.5% vs. 36.4%; P < 0.001) complications during their initial hospitalization and had a 1.5-day longer length of stay during their first admission ( P < 0.001). Those discharged home were less likely to be readmitted within 30 days (20.7% vs. 27.6%, P = 0.008). Multivariate regression revealed increasing American Society of Anesthesiologists class (odds ratio 1.47, P = 0.002) and preinjury ambulatory status (odds ratio 1.42, P = 0.007) was most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, chronic obstructive pulmonary disease exacerbation, and pneumonia.

Conclusions: Thirty-day readmission after hip fracture was associated with older, sicker patients with decreased preinjury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission after hip fracture was pulmonary complications.

Level of evidence: Prognostic Level III. See instructions for authors for a complete description of levels of evidence.

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我们能预测髋部骨折后30天的再入院吗?
目的:确定髋部骨折住院后30天再入院的最常见原因。方法:设计:回顾性研究。环境:单一的学术医疗中心,包括1级创伤中心。患者选择标准:纳入2014年10月至2023年11月期间接受髋部骨折(OTA 31)手术治疗的所有患者。在初次入院期间死亡的患者被排除在外。结果测量和比较:对每位患者的患者人口统计、医院质量测量、结果和出院后30天内的再入院情况进行了回顾。记录30天再入院原因并进行相关性分析。结果:共发现3032例患者,平均年龄82.1岁,70.5%为女性。再入院30天的队列年龄为2.6岁(结论:髋部骨折后再入院30天的患者年龄较大,病情较重,损伤前活动能力下降。股骨颈骨折的半关节置换术也与再入院有关。髋部骨折后30天再入院最常见的原因是肺部并发症。证据等级:预后III级。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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