Factors affecting mortality and hospital admissions after hip surgery among elderly patients with hip fracture in Hong Kong – Review of a three-year follow-up

Objective

Hip fracture is associated with excess mortalities and high rate of hospital re-admission after discharge from the indexed episode. To improve related post-discharge care, we aimed to find out characteristics that were associated with related higher rates of mortality and hospital re-admission.

Methods

This was a historical cohort study with following up of 273 patients recruited in a local rehabilitation hospital for 3 years. The outcome of interest was cumulative mortalities and hospital re-admissions in the 1st 3 years after their discharge from the rehabilitation hospital. These outcomes were collected in the hospital data warehouse – the Clinical Data Analysis and Reporting System (CDARS). Eighteen predictors, as proposed by similar studies and our own review, were retrieved from our standard clinical forms as well as from the CDARS. Binary logistic regression was used to test their association with the outcomes and to generate the respective odd ratios.

Results

The cumulative overall mortality rates at 0.5-, 1-, 2- and 3- year after hip fracture were 7.2%, 14.0%, 24.6% and 33.4% respectively, while the cumulative “1st ever hospital readmission” at 0.5-, 1, 2- and 3- years after hip fracture were 29.4%, 41.6%, 59.4% and 71.7% respectively. The most significant predictors i) for mortality at 3- year were: “Being male” (OR 5.33), “Delayed surgery >48 hours” (OR 2.65), “pre-operation albumin level <3.5 g/dl” (OR 2.66), and, ii) for “1st ever hospital readmission” at 0.5-year was “Being Assisted walker or non-walker (after rehabilitation)” (OR 3.83).

Conclusions

Characteristics that define the groups of patients with hip fractures with higher mortality and rate of hospital re-admission were identified. This could help healthcare professionals to focus on target patient groups for closer monitoring and more intensive post-discharge care.