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Archives of Osteoporosis
Published in: Archives of Osteoporosis 1/2016

01-12-2016 | Original Article

Time trends in hospital stay after hip fracture in Canada, 2004–2012: database study

Authors: Boris Sobolev, Pierre Guy, Katie Jane Sheehan, Lisa Kuramoto, Eric Bohm, Lauren Beaupre, Jason M. Sutherland, Michael Dunbar, Donald Griesdale, Suzanne N. Morin, Edward Harvey, for The Canadian Collaborative Study on Hip Fractures

Published in: Archives of Osteoporosis | Issue 1/2016

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Abstract

Summary

Changes in bed management and access policy aimed to shorten Canadian hip fracture hospital stay. Secular trends in hip fracture total, preoperative, and postoperative stay are unknown. Hip fracture stay shortened from 2004 to 2012, mostly from shortening postoperative stay. This may reflect changes in bed management rather than access policy.

Purpose

To compare the probability of discharge by time after patient admission to hospital with first-time hip fracture over a period of nine calendar years.

Methods

We retrieved acute hospitalization records for 169,595 patients 65 years and older, who were admitted to an acute care hospital with hip fracture between 2004 and 2012 in Canada (outside of Quebec). The main outcome measure was cumulative incidence of discharge by inpatient day, accounting for competing events that end hospital stay.

Results

The probability of surgical discharge within 30 days of admission increased from 57.2 % in 2004 to 67.3 % in 2012. The probability of undergoing surgery on day of admission or day after fluctuated around 58.5 % over the study period. For postoperative stay, the discharge probability increased from 6.8 to 12.2 % at day 4 after surgery and from 57.2 to 66.6 % at day 21 after surgery, between 2004 and 2012. The differences across years persisted after adjustment for characteristics of patients, fracture, comorbidity, treatment, type and timing of surgery, and access to care.

Conclusions

Hospital stay following hip fracture shortened substantially between 2004 and 2012 in Canada, mostly due to shortening of postoperative stays. Shorter hospital stays may reflect changes in bed management protocols rather than in access policy.
Appendix
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Literature
1.
Sutherland JM, Crump RT (2013) Alternative level of care: Canada’s hospital beds, the evidence and options. Healthc Policy 9:26–34PubMedPubMedCentral
2.
Barrett B, Way C, McDonald J, Parfrey P (2005) Hospital utilization, efficiency and access to care during and shortly after restructuring acute care in Newfoundland and Labrador. J Health Serv Res Policy 10(Suppl 2):S2–S7CrossRef
3.
Evans B, Potvin C, Johnson G, Henderson N, Yuen I, Smith T, Metham S, Taylor S, Sniekers D (2011) Enhancing patient flow in an acute care hospital: successful strategies at the Juravinski Hospital. Healthc Q 14:66–74CrossRefPubMed
4.
5.
6.
7.
Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, McLaughlin M, Halm EA, Wang JJ, Litke A, Silberzweig SB, Siu AL (2004) Association of timing of surgery for hip fracture and patient outcomes. JAMA 291:1738–1743CrossRefPubMedPubMedCentral
8.
Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, Misasi M (2015) The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study. Bone Joint J 97-B:383–390CrossRefPubMed
9.
Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, DeBeer J, Bhandari M (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182:1609–1616CrossRefPubMedPubMedCentral
10.
Ho V, Hamilton BH, Roos LL (2000) Multiple approaches to assessing the effects of delays for hip fracture patients in the United States and Canada. Health Serv Res 34:1499–1518PubMedPubMedCentral
11.
Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM (2009) Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg (Br) 91:922–927CrossRef
12.
Canadian Institute for Health Information (2007) Health Indicators 2007. CIHI, Ottawa
13.
Canadian Institute for Health Information (2011) Data quality documentation for external users: Discharge Abstract Database, 2010–2011. CIHI, Ottawa
14.
Ahmed I, Khan MA, Nayak V, Mohsen A (2014) An evidence-based warfarin management protocol reduces surgical delay in hip fracture patients. J Orthop Traumatol 15:21–27CrossRefPubMed
15.
16.
Fransoo R, Yogendran M, Olafson K, Ramsey C, McGowan KL, Garland A (2012) Constructing episodes of inpatient care: data infrastructure for population-based research. BMC Med Res Methodol 12:133CrossRefPubMedPubMedCentral
17.
Kaboli PJ, Go JT, Hockenberry J, Glasgow JM, Johnson SR, Rosenthal GE, Jones MP, Vaughan-Sarrazin M (2012) Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Ann Intern Med 157:837–845CrossRefPubMed
18.
Vidan MT, Sanchez E, Gracia Y, Maranon E, Vaquero J, Serra JA (2011) Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med 155:226–233CrossRefPubMed
19.
Pintilie M (2006) Competing risks, a practical perspective. John Wiley & Sons
20.
Klein JP, Andersen PK (2005) Regression modeling of competing risks data based on pseudovalues of the cumulative incidence function. Biometrics 61:223–229CrossRefPubMed
21.
Bland JM, Altman DG (1998) Survival probabilities (the Kaplan-Meier method). BMJ 317:572
22.
23.
24.
Hojsgaard S, Halekoh U, Yan J (2006) The R package geepack for generalized estimating equations. J Stat Softw 15:1–11
25.
R core team (2015) R: a language and environment for statistical computing
26.
Nikkel LE, Fox EJ, Black KP, Davis C, Andersen L, Hollenbeak CS (2012) Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am 94:9–17CrossRefPubMed
27.
Auais M, Morin S, Nadeau L, Finch L, Mayo N (2013) Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Osteoporos Int 24(10):2713–2724CrossRefPubMed
28.
Ban I, Palm H, Birkelund L, Eschen J, Kring S, Brix M, Troelsen A (2014) Implementing, adapting, and validating an evidence-based algorithm for hip fracture surgery. J Orthop Trauma 28:e21–e26CrossRefPubMed
29.
Moran CG, Wenn RT, Sikand M, Taylor AM (2005) Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am 87:483–489CrossRefPubMed
30.
Ricci WM, Brandt A, McAndrew C, Gardner MJ (2015) Factors affecting delay to surgery and length of stay for patients with hip fracture. J Orthop Trauma 29:e109–e114CrossRefPubMedPubMedCentral
31.
Orosz GM, Hannan EL, Magaziner J, Koval K, Gilbert M, Aufses A, Straus E, Vespe E, Siu AL (2002) Hip fracture in the older patient: reasons for delay in hospitalization and timing of surgical repair. J Am Geriatr Soc 50:1336–1340CrossRefPubMed
32.
Tracey J, Forte T, Fagbemi J, Chaudhary Z (2007) Wait time for hip fracture surgery in Canada. Healthc Q 10:24–27CrossRefPubMed
33.
Motohashi T, Hamada H, Lee J, Sekimoto M, Imanaka Y (2013) Factors associated with prolonged length of hospital stay of elderly patients in acute care hospitals in Japan: a multilevel analysis of patients with femoral neck fracture. Health Policy 111:60–67CrossRefPubMed
34.
Canadian Institute for Health Information (2005) Inpatient hospitalizations and average length od stay trends in Canada, 2003–2004 and 2004–2005. CIHI, Ottawa
35.
Canadian Institute for Health Information (2005) Hospital trends in Canada—results of a project to create a historical series of statistical and financial data for Canadian hospitals over twenty-seven years. CIHI, Ottawa
36.
Kralj B, Kantarevic J (2012) Primary care model enrolment and hospital length of stay in Ontario: patient rostering associated with reduced length of stay, significant health system savings. Ontario Medical Review. 16–19
37.
OECD (2011) Average length of stay in hospitals. In: Health at a Glance 2011: OECD Indicators. OECD Publishing
38.
Neuburger J, Harding KA, Bradley RJ, Cromwell DA, Gregson CL (2014) Variation in access to community rehabilitation services and length of stay in hospital following a hip fracture: a cross-sectional study. BMJ Open 4:e005469CrossRefPubMedPubMedCentral
39.
Nordstrom P, Gustafson Y, Michaelsson K, Nordstrom A (2015) Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ 350:h696CrossRefPubMedPubMedCentral
40.
Williams N, Hardy BM, Tarrant S, Enninghorst N, Attia J, Oldmeadow C, Balogh ZJ (2013) Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre. Arch Osteoporos 8(1–2):150CrossRefPubMed
41.
Holvik K, Ranhoff AH, Martinsen MI, Solheim LF (2010) Predictors of mortality in older hip fracture inpatients admitted to an orthogeriatric unit in Oslo, Norway. J Aging Health 22:1114–1131CrossRefPubMed
42.
Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, Fuld J, Nolte E (2014) Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment. health services and delivery research
43.
Neuburger J, Currie C, Wakeman R, Tsang C, Plant F, De SB, Cromwell DA, van der Meulen J (2015) The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data. Med Care 53:686–691CrossRefPubMedPubMedCentral
44.
Boddaert J, Cohen-Bittan J, Khiami F, Le MY, Raux M, Beinis JY, Verny M, Riou B (2014) Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One 9(1):e83795CrossRefPubMedPubMedCentral
45.
Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134:1261–1269CrossRefPubMed
46.
Leslie WD, O’Donnell S, Jean S, Lagace C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A (2009) Trends in hip fracture rates in Canada. JAMA 302:883–889CrossRefPubMed
47.
Ko FC, Morrison RS (2014) Hip fracture: a trigger for palliative care in vulnerable older adults. JAMA Intern Med 174:1281–1282CrossRefPubMed
48.
Metadata
Title
Time trends in hospital stay after hip fracture in Canada, 2004–2012: database study
Authors
Boris Sobolev
Pierre Guy
Katie Jane Sheehan
Lisa Kuramoto
Eric Bohm
Lauren Beaupre
Jason M. Sutherland
Michael Dunbar
Donald Griesdale
Suzanne N. Morin
Edward Harvey
for The Canadian Collaborative Study on Hip Fractures
Publication date
01-12-2016
Publisher
Springer London
Published in
Archives of Osteoporosis / Issue 1/2016
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-016-0264-5

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