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Coincident with shorter hospital stays, more patients who have undergone hip fracture repair surgery are discharged with active clinical problems that some are concerned may lead to hospital readmission. This concern may be well placed, suggest Kenneth S. Boockvar, M.D., M.S., and Ethan A. Halm, M.D., M.P.H., of the Mount Sinai School of Medicine.
In a recent study, they and their colleagues found that nearly one-third of hip fracture patients were readmitted to the hospital within 6 months after fracture. Most (89 percent) hospital readmissions were for nonsurgical problems, of which infections (21 percent), including pneumonia, and cardiac problems (12 percent) were the most common.
Patients who were readmitted were nearly three times as likely to require total assistance with walking at 6 months and four times as likely to die as hip fracture patients who did not have to be readmitted. Initial discharge location had no significant influence on risk of readmission. Patients discharged home had readmission rates similar to those of patients discharged to a nursing facility or rehabilitation hospital, even after adjusting for confounding factors.
Surgical complications caused 11 percent of readmissions during the 6-month period. Preventing medical and surgical problems that require hospital readmission can help prevent functional decline, long-term nursing home residence, and death after hip fracture, note the researchers. Their findings were based on a prospective study of 562 hip fracture patients aged 50 and older discharged from four hospitals in 1997 and 1998. They used hospital admission/discharge databases, medical record review, patient self-report, and functional measures to determine readmission and the reasons for it. Their work was supported in part by the Agency for Healthcare Research and Quality (HS09973 and HS09459).
See "Hospital readmissions after hospital discharge for hip fracture: Surgical and nonsurgical causes and effect on outcomes," by Drs. Boockvar and Halm, Ann Litke, M.A., and others, in the March 2003 Journal of the American Geriatrics Society 51, pp. 399-403.
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