Short hospital stay linked to increased risk of death following hip fracture
Older patients are more likely to die following a short hospital stay for a hip fracture, finds research published in the British Medical Journal today.
Hip fractures in the elderly are a major cause of disability and associated with an increased risk of death. The growth of the elderly population along with rising healthcare costs has placed considerable strain on hospitals. Consequently hospital bed shortages are now commonplace across Europe and length of stay in hospitals has generally decreased. Previous research has shown mixed results on patient outcomes of shorter length of hospital stay.
A team of researchers, led by Peter Nordström at Umeå University, examined the effect of the length of stay in hospital on the risk of death following a hip fracture among older persons. They looked at 116 111 Swedish residents, aged 50 years and over, who had been admitted to a hospital with a hip fracture between 2006 and 2012. Length of hospital stay, date of death and underlying causes within 30 days of hospital discharge were analysed. Other factors were accounted for including underlying health conditions, medications, socioeconomic status, type of hip fracture and surgery.
Results showed that average length of stay in hospital decreased from 14.2 days in 2006 to 11.6 days in 2012. Patients had an average age of 82.2 years. Patients who stayed in hospital for up to 5 days had twice the risk of death compared with patients staying 15 days or more.
“Our results suggest that the continuous efforts to decrease length of stay after major surgery is associated with higher mortality after hospital discharge,” write the authors.
High risk groups included men, patients with specific fractures along the femur connecting to the hip bone and certain conditions such as, chronic obstructive pulmonary disease, renal failure and cardiovascular disease.
The effect of hospital stays according to number of days was also analysed. Hospital stays of less than 10 days were linked to a higher risk of death. And each one day reduction in hospital stay increased the risk of death by 8% in 2006 and this rose to 16% in 2012. This effect disappeared with hospital stays of 11 days or more. Age was found to be the strongest predictor of risk of death within one year of admission.
Overall, 5 863 (5.0%) patients died during hospital stay, 6 377 (5.5%) people died within 30 days of hospital discharge and 30 053 (25.9%) people died within one year after fracture.
Shorter hospital stay may reduce proper rehabilitation that enables patients to regain mobility, for example, and limits access to medical staff, further assessment and appropriate care, explain the authors.
In a linked editorial, experts from the University of Toronto explain that “healthcare systems around the world are constantly urged to do more with less” and rapid discharge should be carefully considered for each patient.
Some patients may benefit from early discharge while others will not - it depends on each patient’s condition, they argue. Otherwise, cutting hospital stays too early may not result in the desired benefits for hospitals or clinicians because of the risk of certain patients developing complications, which may increase readmissions, and as this study shows, risk of death, they add.