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Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

Hip fracture in hospitalized medical patients

Authors: Antonio Zapatero, Raquel Barba, Jesús Canora, Juan E Losa, Susana Plaza, Jesús San Roman, Javier Marco

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

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Abstract

Background

The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain.

Methods

We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization.
Outcome measures included rates of in-hospital fractures, length of stay and cost.

Results

A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p < 0.001, and the mean length of stay was significantly longer for patients with a hip fracture (20.7 days vs 9.8 days; p < 0.001). Cost were higher in hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49).

Conclusions

In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.
Literature
1.
go back to reference Instituto Nacional de Estadística Anuario Estadístico de España 2008: Demografía. Evolución de la población por grandes grupos de edad. Estimaciones intercensales y actuales de la población. 2008, Madrid Instituto Nacional de Estadística Anuario Estadístico de España 2008: Demografía. Evolución de la población por grandes grupos de edad. Estimaciones intercensales y actuales de la población. 2008, Madrid
2.
go back to reference Alvarez-Nebreda ML, Jimenez AB, Rodriguez P: Epidemiology of hip fracture in the elderly in Spain. Bone. 2008, 42 (2): 278-285. 10.1016/j.bone.2007.10.001.CrossRefPubMed Alvarez-Nebreda ML, Jimenez AB, Rodriguez P: Epidemiology of hip fracture in the elderly in Spain. Bone. 2008, 42 (2): 278-285. 10.1016/j.bone.2007.10.001.CrossRefPubMed
3.
go back to reference Rapp K, Becker C, Lamb SE: Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res. 2008, 23 (11): 1825-1831. 10.1359/jbmr.080702.CrossRefPubMed Rapp K, Becker C, Lamb SE: Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Miner Res. 2008, 23 (11): 1825-1831. 10.1359/jbmr.080702.CrossRefPubMed
4.
go back to reference Uden G, Nilsson B: Hip fracture frequent in hospital. Acta Orthop Scand. 1986, 57 (5): 428-430. 10.3109/17453678609014763.CrossRefPubMed Uden G, Nilsson B: Hip fracture frequent in hospital. Acta Orthop Scand. 1986, 57 (5): 428-430. 10.3109/17453678609014763.CrossRefPubMed
5.
go back to reference Johal KS, Boulton C, Moran CG: Hip fractures after falls in hospital: a retrospective observational cohort study. Injury. 2009, 40 (2): 201-204. 10.1016/j.injury.2008.06.036.CrossRefPubMed Johal KS, Boulton C, Moran CG: Hip fractures after falls in hospital: a retrospective observational cohort study. Injury. 2009, 40 (2): 201-204. 10.1016/j.injury.2008.06.036.CrossRefPubMed
6.
go back to reference Amador LF, Loera JA: Preventing postoperative falls in the older adult. J Am Coll Surg. 2007, 204 (3): 447-453. 10.1016/j.jamcollsurg.2006.12.010.CrossRefPubMed Amador LF, Loera JA: Preventing postoperative falls in the older adult. J Am Coll Surg. 2007, 204 (3): 447-453. 10.1016/j.jamcollsurg.2006.12.010.CrossRefPubMed
7.
go back to reference Hitcho EB, Krauss MJ, Birge S: Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med. 2004, 19 (7): 732739-CrossRef Hitcho EB, Krauss MJ, Birge S: Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med. 2004, 19 (7): 732739-CrossRef
8.
go back to reference Needleman J, Buerhaus P, Mattke S: Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002, 346 (22): 1715-1722. 10.1056/NEJMsa012247.CrossRefPubMed Needleman J, Buerhaus P, Mattke S: Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002, 346 (22): 1715-1722. 10.1056/NEJMsa012247.CrossRefPubMed
9.
go back to reference Myint PK, Poole KE, Warburton EA: Hip fractures after stroke and their prevention. QJM. 2007, 100 (9): 539-545. 10.1093/qjmed/hcm067.CrossRefPubMed Myint PK, Poole KE, Warburton EA: Hip fractures after stroke and their prevention. QJM. 2007, 100 (9): 539-545. 10.1093/qjmed/hcm067.CrossRefPubMed
10.
go back to reference Oliver D: Older people who fall: why they matter and what you can do. Br J Community Nurs. 2007, 12 (11): 500-507.CrossRefPubMed Oliver D: Older people who fall: why they matter and what you can do. Br J Community Nurs. 2007, 12 (11): 500-507.CrossRefPubMed
11.
go back to reference Iezzoni LI, Daley J: A description and clinical assessment of the Computerized Severity Index. QRB Qual Rev Bull. 1992, 18 (2): 44-52.PubMed Iezzoni LI, Daley J: A description and clinical assessment of the Computerized Severity Index. QRB Qual Rev Bull. 1992, 18 (2): 44-52.PubMed
13.
go back to reference Johantgen M, Elixhauser A, Bali JK: Quality indicators using hospital discharge data: state and national applications. Jt Comm J Qual Improv. 1998, 24 (2): 88-105.PubMed Johantgen M, Elixhauser A, Bali JK: Quality indicators using hospital discharge data: state and national applications. Jt Comm J Qual Improv. 1998, 24 (2): 88-105.PubMed
14.
go back to reference University of California at San Francisco-Stanford University Evidenced-Based Practice Center: Evidence report for measures of patient safety based on hospital administrative data-the patient safety indicators. 2002, Rosckville, MD: Agency for Healthcare Research and Quality University of California at San Francisco-Stanford University Evidenced-Based Practice Center: Evidence report for measures of patient safety based on hospital administrative data-the patient safety indicators. 2002, Rosckville, MD: Agency for Healthcare Research and Quality
15.
go back to reference Ministerio de Sanidad y Consumo. España: Validación de indicadores de calidad utilizados en el contexto internacional: indicadores de seguridad de pacientes e indicadores de hospitalización evitable. 2008, Madrid Ministerio de Sanidad y Consumo. España: Validación de indicadores de calidad utilizados en el contexto internacional: indicadores de seguridad de pacientes e indicadores de hospitalización evitable. 2008, Madrid
16.
go back to reference Charlson ME, Pompei P, Ales KL: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40 (5): 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed Charlson ME, Pompei P, Ales KL: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40 (5): 373-383. 10.1016/0021-9681(87)90171-8.CrossRefPubMed
17.
go back to reference Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992, 45: 613619-CrossRef Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992, 45: 613619-CrossRef
19.
go back to reference Raleigh VS, Cooper J, Bremner SA: Patient safety indicators for England from hospital administrative data: case–control analysis and comparison with US data. BMJ. 2008, 337: a1702-10.1136/bmj.a1702.CrossRefPubMedPubMedCentral Raleigh VS, Cooper J, Bremner SA: Patient safety indicators for England from hospital administrative data: case–control analysis and comparison with US data. BMJ. 2008, 337: a1702-10.1136/bmj.a1702.CrossRefPubMedPubMedCentral
20.
go back to reference Brand CA, Sundararajan V: A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Qual Saf Health Care. 2010, 19 (6): e51-10.1136/qshc.2009.038273.PubMed Brand CA, Sundararajan V: A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Qual Saf Health Care. 2010, 19 (6): e51-10.1136/qshc.2009.038273.PubMed
21.
go back to reference Murray GR, Cameron ID, Cumming RG: The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures. J Am Geriatr Soc. 2007, 55 (4): 577-582. 10.1111/j.1532-5415.2007.01102.x.CrossRefPubMed Murray GR, Cameron ID, Cumming RG: The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures. J Am Geriatr Soc. 2007, 55 (4): 577-582. 10.1111/j.1532-5415.2007.01102.x.CrossRefPubMed
22.
go back to reference Foss NB, Palm H, Kehlet H: In-hospital hip fractures: prevalence, risk factors and outcome. Age Ageing. 2005, 34 (6): 642-645. 10.1093/ageing/afi198.CrossRefPubMed Foss NB, Palm H, Kehlet H: In-hospital hip fractures: prevalence, risk factors and outcome. Age Ageing. 2005, 34 (6): 642-645. 10.1093/ageing/afi198.CrossRefPubMed
23.
go back to reference Marcantonio ER, Bergmann MA, Kiely DK: Randomized trial of a delirium abatement program for postacute skilled nursing facilities. J Am Geriatr Soc. 2010, 58 (6): 1019-1026. 10.1111/j.1532-5415.2010.02871.x.CrossRefPubMedPubMedCentral Marcantonio ER, Bergmann MA, Kiely DK: Randomized trial of a delirium abatement program for postacute skilled nursing facilities. J Am Geriatr Soc. 2010, 58 (6): 1019-1026. 10.1111/j.1532-5415.2010.02871.x.CrossRefPubMedPubMedCentral
24.
go back to reference Olofsson B, Stenvall M, Lundstrom M: Malnutrition in hip fracture patients: an intervention study. J Clin Nurs. 2007, 16 (11): 2027-2038. 10.1111/j.1365-2702.2006.01864.x.CrossRefPubMed Olofsson B, Stenvall M, Lundstrom M: Malnutrition in hip fracture patients: an intervention study. J Clin Nurs. 2007, 16 (11): 2027-2038. 10.1111/j.1365-2702.2006.01864.x.CrossRefPubMed
25.
go back to reference Butler M, Norton R, Lee-Joe T: The risks of hip fracture in older people from private homes and institutions. Age Ageing. 1996, 25 (5): 381-385. 10.1093/ageing/25.5.381.CrossRefPubMed Butler M, Norton R, Lee-Joe T: The risks of hip fracture in older people from private homes and institutions. Age Ageing. 1996, 25 (5): 381-385. 10.1093/ageing/25.5.381.CrossRefPubMed
26.
go back to reference Chen JS, Sambrook PN, Simpson JM: Risk factors for hip fracture among institutionalised older people. Age Ageing. 2009, 38 (4): 429-434. 10.1093/ageing/afp051.CrossRefPubMed Chen JS, Sambrook PN, Simpson JM: Risk factors for hip fracture among institutionalised older people. Age Ageing. 2009, 38 (4): 429-434. 10.1093/ageing/afp051.CrossRefPubMed
27.
go back to reference Norton R, Campbell AJ, Reid IR: Residential status and risk of hip fracture. Age Ageing. 1999, 28 (2): 135-139. 10.1093/ageing/28.2.135.CrossRefPubMed Norton R, Campbell AJ, Reid IR: Residential status and risk of hip fracture. Age Ageing. 1999, 28 (2): 135-139. 10.1093/ageing/28.2.135.CrossRefPubMed
28.
go back to reference Chapuy MC, Arlot ME, Duboeuf F: Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992, 327 (23): 1637-1642. 10.1056/NEJM199212033272305.CrossRefPubMed Chapuy MC, Arlot ME, Duboeuf F: Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992, 327 (23): 1637-1642. 10.1056/NEJM199212033272305.CrossRefPubMed
29.
go back to reference Fonda D, Cook J, Sandler V: Sustained reduction in serious fall-related injuries in older people in hospital. Med J Aust. 2006, 184 (8): 379-382.PubMed Fonda D, Cook J, Sandler V: Sustained reduction in serious fall-related injuries in older people in hospital. Med J Aust. 2006, 184 (8): 379-382.PubMed
30.
go back to reference Haines TP, Bennell KL, Osborne RH: Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ. 2004, 328 (7441): 676-10.1136/bmj.328.7441.676.CrossRefPubMedPubMedCentral Haines TP, Bennell KL, Osborne RH: Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ. 2004, 328 (7441): 676-10.1136/bmj.328.7441.676.CrossRefPubMedPubMedCentral
Metadata
Title
Hip fracture in hospitalized medical patients
Authors
Antonio Zapatero
Raquel Barba
Jesús Canora
Juan E Losa
Susana Plaza
Jesús San Roman
Javier Marco
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-15

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