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Archives of Osteoporosis

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01-12-2022 | Anemia | Original Article

End stage renal disease patients undergoing hip fracture surgery have increased length of stay, acute hospital bill size, and reduced survivorship—implications on a bundled care program

Authors: Louise Woon Theng Lo, Yanling Xu, Tet Sen Howe, Joyce Suang Bee Koh, Ngai Nung Lo, Youheng Ou Yang

Published in: Archives of Osteoporosis | Issue 1/2022

Abstract

Summary

End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rates. As these patients significantly skew healthcare financing in a bundled care payment (BCP) program, a risk stratified approach to BCPs could be done to take into account the difference in resources required.

Introduction

End stage renal disease (ESRD) is an independent risk factor for the development of hip fractures and is associated with a higher mortality and complication rate. Hip fracture patients with ESRD may significantly skew healthcare financing in a bundled care payment (BCP) program.

Materials and methods

ESRD patients undergoing hip fracture surgery from June 2007 to June 2012 within a tertiary hospital in Singapore were identified and matched to two other controls without ESRD based on secondary features of sex, age, fracture type, and surgery performed. Data was collected for American Society of Anesthesiologist (ASA) score, duration of surgery (DOS), length of stay (LOS), 30-day and 1-year mortality, and the presence of 10 other comorbidities: diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLD), ischemic heart disease (IHD), arrhythmia (ARR), cerebrovascular disease (CVA), dementia (DEM), asthma (ASTH), peripheral vascular disease (PVD), and anemia (ANE) from electronic medical records. Costs were retrieved from the gross acute hospitalization bill.

Results

Forty-one ESRD patients were successfully matched with 82 controls. Patients with ESRD had higher ASA scores (3 vs 2, p = 0.0001), had 75% higher LOS (21 vs 12 days, p < 0.0001), were associated with 67% higher healthcare expenditure (median $20542 vs $12236, p < 0.0001), and 1-year mortality (OR: 19.6, p < 0.0001). ESRD patients had an average of 4.1 comorbidities per patient compared to 1.84 in the control group.

Conclusion

ESRD is an outsized factor on the outcome of hip fracture patients who have markedly higher and more variable healthcare utilization.

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Title: End stage renal disease patients undergoing hip fracture surgery have increased length of stay, acute hospital bill size, and reduced survivorship—implications on a bundled care program
Authors: Louise Woon Theng Lo
Yanling Xu
Tet Sen Howe
Joyce Suang Bee Koh
Ngai Nung Lo
Youheng Ou Yang
Publication date: 01-12-2022
Publisher: Springer London
Keywords: Anemia
Surgery
Care
Peripheral Arterial Disease
Peripheral Arterial Disease
Published in: Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-022-01103-y

At a glance: The STEP trials

Springer Medicine

End stage renal disease patients undergoing hip fracture surgery have increased length of stay, acute hospital bill size, and reduced survivorship—implications on a bundled care program

Abstract

Summary

Introduction

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Materials and methods

Results

Conclusion

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