RT Journal Article
SR Electronic
T1 In-hospital mortality after hip fracture by treatment setting
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.160522
DO 10.1503/cmaj.160522
A1 Katie J. Sheehan
A1 Boris Sobolev
A1 Pierre Guy
A1 Lisa Kuramoto
A1 Suzanne N. Morin
A1 Jason M. Sutherland
A1 Lauren Beaupre
A1 Donald Griesdale
A1 Michael Dunbar
A1 Eric Bohm
A1 Edward Harvey
A1 for The Canadian Collaborative Study of Hip Fractures*
YR 2016
UL http://www.cmaj.ca/content/early/2016/10/17/cmaj.160522.abstract
AB Background: Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.Methods: We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.Results: Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.Interpretation: Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.