Abstract
ObjectiveIn hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and ‘length of hospital stay’, ‘priority of surgery’, ‘time of surgery’, or ‘surgical delay’ in hip fracture surgery.DesignObservational cohort study.SettingProspectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis, anaesthetic and surgical procedures were retrieved.Participants6143 patients aged more than 65 years undergoing hip fracture surgery.Main Outcome MeasuresAll-cause mortality.ResultsThe one year mortality was 30% (28–31%, 95% Confidence interval (CI)). In a multivariate model ‘length of hospital stay’ less than 10 days and more than 20 days are associated with mortality with hazard ratios of 1.34 (1.20–1.53 CI, p<0.001) and 1.27 (1.06–1.51 CI, p<0.001), respectively. ‘Priority of surgery’ categorized as ‘non-scheduled’ is associated with mortality with a hazard ratio of 1.31 (1.13–1.50 CI, p<0.001). Surgical delay and time of surgery are not significantly associated with mortality.ConclusionNon-scheduled surgery and length of hospital stay were associated with increased mortality. Confounding by indication may bias observational studies evaluating early and late discharge as well as priority; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors.
Highlights
Mortality after hip fracture surgery is high and has been reported to range from 14 to 36% after one year [1]
In a multivariate model ‘length of hospital stay’ less than 10 days and more than 20 days are associated with mortality with hazard ratios of 1.34 (1.20–1.53 CI, p, 0.001) and 1.27 (1.06–1.51 CI, p,0.001), respectively
Non-scheduled surgery and length of hospital stay were associated with increased mortality
Summary
Mortality after hip fracture surgery is high and has been reported to range from 14 to 36% after one year [1]. The administrative management consist of interventions strongly depending on numerous conditions related to the patient, the physician etc As an example both ‘surgical delay’ and ‘length of hospital stay’ is probably affected by organizational (i.e., the time required for the diagnostic procedures) and clinical (i.e., the development of intercurrent adverse clinical events) factors. Length of hospital stay has primarily been evaluated as an outcome measure [2;14;17;18] rather than a determinant for mortality In this large cohort study with prospectively and consecutively recorded data, we evaluated the impact of factors partly categorized as organizational such as ‘surgical delay’, ‘length of hospital stay’, ‘time of surgery’ and ‘surgical priority’ on long-term mortality after hip fracture surgery
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