Abstract
Background and PurposeAn ageing population at greater risk of proximal femoral fracture places an additional clinical and financial burden on hospital and community medical services. We analyse the variation in i) length of stay (LoS) in hospital and ii) costs across the acute care pathway for hip fracture from emergency admission, to hospital stay and follow-up outpatient appointments.Patients and MethodsWe analyse patient-level data from England for 2009/10 for around 60,000 hip fracture cases in 152 hospitals using a random effects generalized linear multi-level model where the dependent variable is given by the patient’s cost or length of stay (LoS). We control for socio-economic characteristics, type of fracture and intervention, co-morbidities, discharge destination of patients, and quality indicators. We also control for provider and social care characteristics.ResultsOlder patients and those from more deprived areas have higher costs and LoS, as do those with specific co-morbidities or that develop pressure ulcers, and those transferred between hospitals or readmitted within 28 days. Costs are also higher for those having a computed tomography (CT) scan or cemented arthroscopy. Costs and LoS are lower for those admitted via a 24h emergency department, receiving surgery on the same day of admission, and discharged to their own homes.InterpretationPatient and treatment characteristics are more important as determinants of cost and LoS than provider or social care factors. A better understanding of the impact of these characteristics can support providers to develop treatment strategies and pathways to better manage this patient population.
Highlights
Proximal femoral fracture (PFF) or hip fracture is one of the commonest reasons for admission to an orthopaedic trauma ward
We analyse the variation in i) length of stay (LoS) in hospital and ii) costs across the acute care pathway for hip fracture from emergency admission, to hospital stay and follow-up outpatient appointments
Patient and treatment characteristics are more important as determinants of cost and LoS than provider or social care factors
Summary
Proximal femoral fracture (PFF) or hip fracture is one of the commonest reasons for admission to an orthopaedic trauma ward. It is usually caused by a fall suffered by older people with osteoporosis or osteopaenia. Residents of care and nursing homes account for about 30% of all patients admitted to hospital with a PFF. An ageing population at greater risk of PFF will place an additional burden on hospital and community medical services. An ageing population at greater risk of proximal femoral fracture places an additional clinical and financial burden on hospital and community medical services. We analyse the variation in i) length of stay (LoS) in hospital and ii) costs across the acute care pathway for hip fracture from emergency admission, to hospital stay and follow-up outpatient appointments
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