Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis

Purpose Readmissions are common and complicate recovery after hip fracture. The objective of this study was to study readmission rates, factors associated with readmissions and effects of orthogeriatric liaison service in a setting where patients are discharged typically on the first postoperative day from the operating tertiary care hospital to lower-level health care units. Methods A regionally representative cohort of 763 surgically treated hip fracture patients aged >= 50 years was included in this retrospective study, based on hospital discharge records. Primary outcome was a 30-day readmission, while the secondary outcome was a composite outcome, defined as readmission or death with a follow-up of 1 year at maximum. Results The 30-day readmission rate was 8.3% and 1-year mortality was 22.1%. Short length of stay did not lead to poorer outcomes. Delay from admission to surgery of >= 4 days and discharge to primary health care wards were associated with an increased 30-day readmission rate. Age >= 90 years, delay to surgery, postoperative length of stay of >= 2 days and discharge on a Saturday were associated with higher risk for the composite outcome. Use of orthogeriatric liaison service at the operating hospital was associated with a lower risk of 30-day readmissions (11.8% vs. 6.2%, P = 0.012) whereas in longer follow-up readmissions seemed to cumulate similarly independent of orthogeriatric contribution. Patients living in the largest community in the area were discharged to a secondary care orthogeriatric ward and had a lower risk of 30-day readmissions than other patients (4.8% vs. 10.2%, P = 0.009). Conclusion Use of orthogeriatric liaison service and later care at secondary care orthogeriatric ward seem to be beneficial for hip fracture patients in terms of reducing readmissions and mortality. Of the other care-related factors, short delay from admission to surgery and short total length of stay in the operating hospital was also associated with these outcomes, which, however, may relate to the effects of patient characteristics rather than the care process. Key summary pointsAim To study the readmission rates and predictors of readmission following hip fracture surgery in a tertiary care centre with the very short postoperative length of stay. Findings Postoperative length of stay of only 1-2 days did not increase the risk of readmissions. Delay to surgery, prolonged length of stay, not receiving orthogeriatric contribution and discharge to primary rather than secondary care were associated higher readmission rate and/or mortality. Message Although a very short stay in the operating hospital appears safe, hip fracture patients should not be discharged to primary care wards with insufficient resources for managing the acute postoperative phase.