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Clinical Orthopaedics and Related Research®

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01-06-2012 | Clinical Research

Mortality Rates are Similar after Hip Fractures for Rural and Urban Patients

Authors: Benjamin J. Miller, MD, Xueya Cai, PhD, Peter Cram, MD, MBA

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2012

Abstract

Background

Proximal femoral fractures are common in the elderly. The best care depends on expeditious presentation, medical stabilization, and treatment of the condition.

Questions/purposes

We investigated the risk of increased mortality in residents of rural communities secondary to inaccessible facilities and treatment delays.

Patients and Methods

We used Medicare Provider Analysis and Review Part A data to identify 338,092 patients with hip fractures. Each patient was categorized as residing in urban, large rural, or small rural areas. We compared the distance traveled, mortality rates, time from admission to surgery, and length of stay for patients residing in each location.

Results

Patients in rural areas traveled substantially farther to reach their treating facility than did urban patients: mean, 34.4 miles for small rural, 14.5 miles for large rural, and 9.3 miles for urban. The adjusted odds ratios for mortality were similar but slightly better for urban patients for in-hospital mortality (small rural odds ratio, 1.05; large rural odds ratio, 1.13). Rural patients had a favorable adjusted odds ratio for 1-year mortality when compared with urban patients (small rural odds ratio, 0.93; large rural odds ratio, 0.96). Rural patients experienced no greater delay in time to surgery or longer hospital length of stay.

Conclusions

Although patients living in rural areas traveled a greater distance than those living in urban centers, we found no increase in time to surgery, hospital length of stay, or mortality.

Level of Evidence

Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Abrams TE, Vaughan-Sarrazin M, Kaboli PJ. Mortality and revascularization following admission for acute myocardial infarction: implication for rural veterans. J Rural Health. 2010;26:310–317.PubMedCrossRef

Ambardekar AV, Fonarow GC, Dai D, Peterson ED, Hernandez AF, Cannon CP, Krantz MJ; Get With The Guidelines Steering Committee and Hospitals. Quality of care and in-hospital outcomes in patients with coronary heart disease in rural and urban hospitals (from Get With the Guidelines-Coronary Artery Disease Program). Am J Cardiol. 2010;105:139–143.PubMedCrossRef

American Hospital Association (AHA). http://www.ahadata.com/ahadata/html/AHASurvey.html.

Baldwin LM, Cai Y, Larson EH, Dobie SA, Wright GE, Goodman DC, Matthews B, Hart LG. Access to cancer services for rural colorectal cancer patients. J Rural Health. 2008;24:390–399.PubMedCrossRef

Baldwin LM, MacLehose RF, Hart LG, Beaver SK, Every N, Chan L. Quality of care for acute myocardial infarction in rural and urban US hospitals. J Rural Health. 2004;20:99–108.PubMedCrossRef

Barone AP, Fusco D, Colais P, D’Ovidio M, Belleudi V, Agabiti N, Sorge C, Davoli M, Perucci CA. Effects of socioeconomic position on 30-day mortality and wait for surgery after hip fracture. Int J Qual Health Care. 2009;21:379–386.PubMedCrossRef

Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–1579.PubMedCrossRef

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna FS, Wluka AE. The association between urban or rural locality and hip fracture in community-based adults: a systematic review. J Epidemiol Community Health. 2010;64:656–665.PubMedCrossRef

Cram P, Vaughan-Sarrazin MS, Wolf B, Katz JN, Rosenthal GE. A comparison of total hip and knee replacement in specialty and general hospitals. J Bone Joint Surg Am. 2007;89:1675–1684.PubMedCrossRef

10.

Dimick JB. Disparities in access to care: Does it translate into worse outcomes?: Comment on “Possible geographical barriers to trauma center access for vulnerable patients in the United States”. Arch Surg. 2011;146:52.PubMedCrossRef

11.

Drew J, Cashman SB, Savageau JA, Stenger J. The visiting specialist model of rural health care delivery: a survey in Massachusetts. J Rural Health. 2006;22:294–299.PubMedCrossRef

12.

Egede LE, Gebregziabher M, Hunt KJ, Axon RN, Echols C, Gilbert GE, Mauldin PD. Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes. Diabetes Care. 2011;34:938–943.PubMedCrossRef

13.

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMedCrossRef

14.

Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS. Hip fracture incidence in central norway: a followup study. Clin Orthop Relat Res. 2004;419:173–178.PubMedCrossRef

15.

Hsia R, Shen YC. Possible geographical barriers to trauma center access for vulnerable patients in the United States: an analysis of urban and rural communities. Arch Surg. 2011;146:46–52.PubMedCrossRef

16.

Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83:1622–1629.PubMedCrossRef

17.

Medicare Provider Analysis and Review (MedPAR). https://www.cms.gov/IdentifiableDataFiles/05_MedicareProviderAnalysisandReviewFile.asp#TopOfPage.

18.

Melton LJ 3rd, Kearns AE, Atkinson EJ, Bolander ME, Achenbach SJ, Huddleston JM, Therneau TM, Leibson CL. Secular trends in hip fracture incidence and recurrence. Osteoporos Int. 2009;20:687–694.PubMedCrossRef

19.

Nguyen-Oghalai TU, Kuo YF, Wu H, Shokar NK, Grecula M, Tincher S, Ottenbacher KJ. The impact of race/ethnicity on preoperative time to hip stabilization procedure after hip fracture. South Med J. 2010;103:414–418.PubMedCrossRef

20.

Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291:1738–1743.PubMedCrossRef

21.

Peterson LE, Dodoo M, Bennett KJ, Bazemore A, Phillips RL Jr. Nonemergency medicine-trained physician coverage in rural emergency departments. J Rural Health. 2008;24:183–188.PubMedCrossRef

22.

Phibbs CS, Luft HS. Correlation of travel time on roads versus straight line distance. Med Care Res Rev. 1995;52:532–542.PubMedCrossRef

23.

Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008;90:34–42.PubMedCrossRef

24.

Schwartz MR. The physician pipeline to rural and underserved areas in Pennsylvania. J Rural Health. 2008;24:384–389.PubMedCrossRef

25.

Sheikh K, Bullock C. Urban-rural differences in the quality of care for medicare patients with acute myocardial infarction. Arch Intern Med. 2001;161:737–743.PubMedCrossRef

26.

Smektala R, Endres HG, Dasch B, Maier C, Trampisch HJ, Bonnaire F, Pientka L. The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures. BMC Musculoskelet Disord. 2008;9:171.PubMedCrossRef

27.

Verbeek DO, Ponsen KJ, Goslings JC, Heetveld MJ. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients. Int Orthop. 2008;32:13–18.PubMedCrossRef

28.

Vestergaard P, Rejnmark L, Mosekilde L. Has mortality after a hip fracture increased? J Am Geriatr Soc. 2007;55:1720–1726.PubMedCrossRef

29.

Vidan MT, Sanchez E, Gracia Y, Maranon E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011;155:226–233.PubMed

30.

Weller I, Wai EK, Jaglal S, Kreder HJ. The effect of hospital type and surgical delay on mortality after surgery for hip fracture. J Bone Joint Surg Br. 2005;87:361–366.PubMed

31.

WWAMI Rural Health Research Center. Rural-urban commuting area codes (RUCAs). Available at: http://depts.washington.edu/uwruca. Accessed 26 Jan 2011.

Title: Mortality Rates are Similar after Hip Fractures for Rural and Urban Patients
Authors: Benjamin J. Miller, MD
Xueya Cai, PhD
Peter Cram, MD, MBA
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2140-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mortality Rates are Similar after Hip Fractures for Rural and Urban Patients

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Patients and Methods

Results

Conclusions

Level of Evidence

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