Session II - Geriatric

Fri., 10/11/13 Geriatric, PAPER #42, 8:23 am OTA 2013

Rehospitalization After Surgically Treated Hip Fractures: Targets for Intervention

Christopher M. McAndrew, MD; Michael J. Gardner, MD; Ellen F. Binder, MD;
William M. Ricci, MD; Eric J. Lenze, MD;
Washington University School of Medicine, St. Louis, Missouri, USA

Background/Purpose: Unintended 30-day rehospitalization cost Medicare $17.4 billion in 2004. The U.S. Department of Health and Human Services declared a goal of decreased rehospitalization rate by 20% in 2013. Rehospitalization rate after hip fracture is 18%, according to a Medicare claims review. This study of elderly hip fracture patients aims to identify risk factors for rehospitalization, directing future intervention and study.

Methods: Patients over 60 years of age with a femoral neck or intertrochanteric femur fracture treated surgically at 10 hospitals from May 2008 to November 2011 enrolled in a prospective cohort study. Subjects with cognitive impairment (Short Blessed Scale <14) that persisted for 1 week after surgical treatment were excluded. Scheduled periodic follow-up over 1 year was conducted by trained interviewers. At 1, 2, 4, 8, and 12-week interviews, the enrollees and their caregivers were questioned regarding new diagnoses, medications, and hospitalizations. Reasons for rehospitalization came from self or family reporting. 609 patients underwent screening for enrollment. 138 patients were excluded and 70 patients electively withdrew prior to completion of the study, leaving 471 subjects.

Results: Of 471 patients who participated in the study, 33 (7.0%) patients died during the 1-year study period. 388 subjects (82.4%) provided complete 12-week data. Of these 388 patients, 42 (10.8%) and 78 (20.1%) were rehospitalized at 30 and 90 days, respectively. Additionally, 5 patients were rehospitalized twice in the first 30 days. Categorized results show that hip-related complications (pain, dislocation, need for revision surgery) were the most common reasons for rehospitalization, making up 17% of the 30-day and 16% of the 90-day rehospitalizations. Gastrointestinal (GI) complications, including infection and bleeding, were the second most common reasons for rehospitalization at both 30 (15%) and 90 days (13%). Thromboembolism (11% and 12%) was also a common reason for return to the hospital.

Conclusion: 30-day rehospitalization (10.8%) and 1-year mortality (7.0%) rates in a cohort study of cognitively intact patients were lower than historical rates. Mechanical hip complications and hip pain were the most common reasons to be rehospitalized in the first 30 and 90 days after treatment of hip fracture. The proportion of hip complications did not change between the 30-day and 90-day time periods. Potential targets for intervention to decrease rehospitalization include orthopaedic surgical treatment, prevention of GI and pulmonary infection, and thromboembolic prevention and streamlined management.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.