Can we improve early readmission after hip fracture of the adult? A retrospective analysis of 57.544 patients from SNHFR

Hip fractures in the older persons are associated with high morbidity and mortality rates, with a growing incidence due to an aging population. Early readmission increases dependence and healthcare costs, and identifying the factors associated with readmission could improve care. This study aims to identify factors associated with 30-day readmission following hip fracture in patients aged 75 and older, as well as to explore the relationship between various clinical variables.

A multicentric, retrospective observational study was conducted using data from the National Hip Fracture Registry (NHFR) involving 57,544 patients admitted from January 1, 2017, to December 31, 2022. Patients were excluded if they had died during acute hospitalization or were lost to follow-up. Key demographic, clinical, and surgical variables were collected and analysed. Statistical analyses were performed using RStudio, employing both univariate and multivariate regression models to identify predictors of 30-day readmission.

The study revealed a 30-day readmission rate of 5.18 %. Factors significantly protective against readmission included female gender (OR 0.84 p < 0.001), intertrochanteric (OR 0.81 p < 0.008) and subtrochanteric (OR 0.74 p < 0.007) fracture type, neuraxial anaesthesia (OR 0.82 p < 0.015), and increased length of stay (OR 0.98 p < 0.001). Conversely, ASA IV (OR 1.93 p < 0.05), ASA V (OR 5.59 p < 0.05) and discharge to residential care were associated with increased readmission risk. Notably, patients discharged home showed a reduced risk of readmission compared to those transferred to other care facilities such as residential care (OR 1.26 p < 0.001), acute hospitalization (OR 35.46 p < 0.001) and long-term care hospital(OR 2.36 p < 0.001).

The readmission rate observed was lower than the reported by comparable registries. Identifying patients at high risk of early readmission following hip fracture is critical for enhancing patient care, and specific variables can serve as effective predictors, enabling targeted interventions to reduce readmission rates.