In-hospital mortality after hip fracture by treatment setting
Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada. We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture in...
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| Veröffentlicht in: | Canadian Medical Association journal (CMAJ) 2016-12, Vol.188 (17-18), p.1219-1225 |
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| creator | Sheehan, Katie J Sobolev, Boris Guy, Pierre Kuramoto, Lisa Morin, Suzanne N Sutherland, Jason M Beaupre, Lauren Griesdale, Donald Dunbar, Michael Bohm, Eric Harvey, Edward |
| description | Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.
We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.
Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.
Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences. |
| doi_str_mv | 10.1503/cmaj.160522 |
| format | Article |
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We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.
Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.
Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.</description><identifier>ISSN: 0820-3946</identifier><identifier>EISSN: 1488-2329</identifier><identifier>DOI: 10.1503/cmaj.160522</identifier><identifier>PMID: 27754892</identifier><identifier>CODEN: CMAJAX</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Aged ; Aged, 80 and over ; Analysis ; Arrhythmias, Cardiac - epidemiology ; Arthroplasty ; Canada - epidemiology ; Comorbidity ; Diabetes Mellitus - epidemiology ; Female ; Fracture Fixation, Internal ; Fractures ; Heart Failure - epidemiology ; Hip Fractures - epidemiology ; Hip Fractures - surgery ; Hip joint ; Hospital Bed Capacity - statistics & numerical data ; Hospital care ; Hospital Mortality ; Hospitals, Community - statistics & numerical data ; Hospitals, Teaching - statistics & numerical data ; Humans ; Hypertension - epidemiology ; Length of Stay - statistics & numerical data ; Male ; Management ; Mortality ; Myocardial Ischemia - epidemiology ; Odds Ratio ; Postoperative Period ; Pulmonary Disease, Chronic Obstructive - epidemiology ; Regression Analysis ; Teaching hospitals</subject><ispartof>Canadian Medical Association journal (CMAJ), 2016-12, Vol.188 (17-18), p.1219-1225</ispartof><rights>2016 Canadian Medical Association or its licensors.</rights><rights>COPYRIGHT 2016 Joule Inc.</rights><rights>Copyright 8872147 Canada Inc. Dec 6, 2016</rights><rights>2016 Joule Inc. or its licensors 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c640t-2c4db67aa6fb3754a0e4a53a0dda37588a33c8b33e8aeca222d40f0f19d8ade73</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135491/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5135491/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27754892$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sheehan, Katie J</creatorcontrib><creatorcontrib>Sobolev, Boris</creatorcontrib><creatorcontrib>Guy, Pierre</creatorcontrib><creatorcontrib>Kuramoto, Lisa</creatorcontrib><creatorcontrib>Morin, Suzanne N</creatorcontrib><creatorcontrib>Sutherland, Jason M</creatorcontrib><creatorcontrib>Beaupre, Lauren</creatorcontrib><creatorcontrib>Griesdale, Donald</creatorcontrib><creatorcontrib>Dunbar, Michael</creatorcontrib><creatorcontrib>Bohm, Eric</creatorcontrib><creatorcontrib>Harvey, Edward</creatorcontrib><creatorcontrib>Canadian Collaborative Study of Hip Fractures</creatorcontrib><title>In-hospital mortality after hip fracture by treatment setting</title><title>Canadian Medical Association journal (CMAJ)</title><addtitle>CMAJ</addtitle><description>Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.
We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.
Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.
Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Arrhythmias, Cardiac - epidemiology</subject><subject>Arthroplasty</subject><subject>Canada - epidemiology</subject><subject>Comorbidity</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Female</subject><subject>Fracture Fixation, Internal</subject><subject>Fractures</subject><subject>Heart Failure - epidemiology</subject><subject>Hip Fractures - epidemiology</subject><subject>Hip Fractures - surgery</subject><subject>Hip joint</subject><subject>Hospital Bed Capacity - statistics & numerical data</subject><subject>Hospital care</subject><subject>Hospital Mortality</subject><subject>Hospitals, Community - statistics & numerical data</subject><subject>Hospitals, Teaching - statistics & numerical data</subject><subject>Humans</subject><subject>Hypertension - epidemiology</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Management</subject><subject>Mortality</subject><subject>Myocardial Ischemia - epidemiology</subject><subject>Odds Ratio</subject><subject>Postoperative Period</subject><subject>Pulmonary Disease, Chronic Obstructive - epidemiology</subject><subject>Regression Analysis</subject><subject>Teaching hospitals</subject><issn>0820-3946</issn><issn>1488-2329</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqV0tuL1DAUB-AiijuuPvkuxQVRpGNubdMHhWXxMrAoeHkOp-npTIa26SapOP-9GWZdpzIvNg-h7ZffSchJkqeULGlO-Bvdw3ZJC5Izdi9ZUCFlxjir7icLIhnJeCWKs-SR91sSH87Kh8kZK8tcyIotkrerIdtYP5oAXdpbFycTdim0AV26MWPaOtBhcpjWuzQ4hNDjEFKPIZhh_Th50ELn8cntfJ78-PD--9Wn7PrLx9XV5XWmC0FCxrRo6qIEKNqax8pAUEDOgTQNxHcpgXMta85RAmpgjDWCtKSlVSOhwZKfJ-8OueNU99jouAUHnRqd6cHtlAWj5n8Gs1Fr-1PllOeiojHg5W2AszcT-qB64zV2HQxoJ6-ojC7Cooj04h-6tZMb4vGiEpJURUnyv2oNHSoztDbW1ftQdSlKJsqc0n3Z7IRa44Bxk3bA1sTPM__8hNejuVHHaHkCxdFgb_TJ1FezBdEE_BXWMHmvVt--_of9PLcvjuwGoQsbb7spGDv4OXx9gNpZ7x22dzdHidr3sNr3sDr0cNTPji_7zv5pWv4b9w_nzQ</recordid><startdate>20161206</startdate><enddate>20161206</enddate><creator>Sheehan, Katie J</creator><creator>Sobolev, Boris</creator><creator>Guy, Pierre</creator><creator>Kuramoto, Lisa</creator><creator>Morin, Suzanne N</creator><creator>Sutherland, Jason M</creator><creator>Beaupre, Lauren</creator><creator>Griesdale, Donald</creator><creator>Dunbar, Michael</creator><creator>Bohm, Eric</creator><creator>Harvey, Edward</creator><general>Joule Inc</general><general>CMA Impact, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M3G</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161206</creationdate><title>In-hospital mortality after hip fracture by treatment setting</title><author>Sheehan, Katie J ; Sobolev, Boris ; Guy, Pierre ; Kuramoto, Lisa ; Morin, Suzanne N ; Sutherland, Jason M ; Beaupre, Lauren ; Griesdale, Donald ; Dunbar, Michael ; Bohm, Eric ; Harvey, Edward</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c640t-2c4db67aa6fb3754a0e4a53a0dda37588a33c8b33e8aeca222d40f0f19d8ade73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Arrhythmias, Cardiac - epidemiology</topic><topic>Arthroplasty</topic><topic>Canada - epidemiology</topic><topic>Comorbidity</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Female</topic><topic>Fracture Fixation, Internal</topic><topic>Fractures</topic><topic>Heart Failure - epidemiology</topic><topic>Hip Fractures - epidemiology</topic><topic>Hip Fractures - surgery</topic><topic>Hip joint</topic><topic>Hospital Bed Capacity - statistics & numerical data</topic><topic>Hospital care</topic><topic>Hospital Mortality</topic><topic>Hospitals, Community - statistics & numerical data</topic><topic>Hospitals, Teaching - statistics & numerical data</topic><topic>Humans</topic><topic>Hypertension - epidemiology</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Management</topic><topic>Mortality</topic><topic>Myocardial Ischemia - epidemiology</topic><topic>Odds Ratio</topic><topic>Postoperative Period</topic><topic>Pulmonary Disease, Chronic Obstructive - epidemiology</topic><topic>Regression Analysis</topic><topic>Teaching hospitals</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sheehan, Katie J</creatorcontrib><creatorcontrib>Sobolev, Boris</creatorcontrib><creatorcontrib>Guy, Pierre</creatorcontrib><creatorcontrib>Kuramoto, Lisa</creatorcontrib><creatorcontrib>Morin, Suzanne N</creatorcontrib><creatorcontrib>Sutherland, Jason M</creatorcontrib><creatorcontrib>Beaupre, Lauren</creatorcontrib><creatorcontrib>Griesdale, Donald</creatorcontrib><creatorcontrib>Dunbar, Michael</creatorcontrib><creatorcontrib>Bohm, Eric</creatorcontrib><creatorcontrib>Harvey, Edward</creatorcontrib><creatorcontrib>Canadian Collaborative Study of Hip Fractures</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business & Current Affairs Database</collection><collection>Canadian Business & Current Affairs Database (Alumni Edition)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database (ProQuest)</collection><collection>CBCA Reference & Current Events</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Medical Association journal (CMAJ)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sheehan, Katie J</au><au>Sobolev, Boris</au><au>Guy, Pierre</au><au>Kuramoto, Lisa</au><au>Morin, Suzanne N</au><au>Sutherland, Jason M</au><au>Beaupre, Lauren</au><au>Griesdale, Donald</au><au>Dunbar, Michael</au><au>Bohm, Eric</au><au>Harvey, Edward</au><aucorp>Canadian Collaborative Study of Hip Fractures</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>In-hospital mortality after hip fracture by treatment setting</atitle><jtitle>Canadian Medical Association journal (CMAJ)</jtitle><addtitle>CMAJ</addtitle><date>2016-12-06</date><risdate>2016</risdate><volume>188</volume><issue>17-18</issue><spage>1219</spage><epage>1225</epage><pages>1219-1225</pages><issn>0820-3946</issn><eissn>1488-2329</eissn><coden>CMAJAX</coden><abstract>Where patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.
We examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.
Compared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.
Compared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>27754892</pmid><doi>10.1503/cmaj.160522</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Canadian Medical Association journal (CMAJ), 2016-12, Vol.188 (17-18), p.1219-1225 |
| issn | 0820-3946 1488-2329 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Journals@Ovid Complete; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Analysis Arrhythmias, Cardiac - epidemiology Arthroplasty Canada - epidemiology Comorbidity Diabetes Mellitus - epidemiology Female Fracture Fixation, Internal Fractures Heart Failure - epidemiology Hip Fractures - epidemiology Hip Fractures - surgery Hip joint Hospital Bed Capacity - statistics & numerical data Hospital care Hospital Mortality Hospitals, Community - statistics & numerical data Hospitals, Teaching - statistics & numerical data Humans Hypertension - epidemiology Length of Stay - statistics & numerical data Male Management Mortality Myocardial Ischemia - epidemiology Odds Ratio Postoperative Period Pulmonary Disease, Chronic Obstructive - epidemiology Regression Analysis Teaching hospitals |
| title | In-hospital mortality after hip fracture by treatment setting |
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