Nikkel Lucas E, Kates Stephen L, Schreck Michael, Maceroli Michael, Mahmood Bilal, Elfar John C
University of Rochester, Department of Orthopaedics, Rochester, NY 14642, USA.
Virginia Commonwealth University, Richmond, VA, USA.
BMJ. 2015 Dec 10;351:h6246. doi: 10.1136/bmj.h6246.
Can the length of hospital stay for hip fracture affect a patient's risk of death 30 days after discharge?
In a retrospective cohort study, population based registry data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used to investigate 188,208 patients admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients were aged 50 years and older, and received surgical or non-surgical treatment. The main outcome measure was the mortality rate at 30 days after hospital discharge.
Hospital stays of 11-14 days for hip fracture were associated with a 32% increased odds of death 30 days after discharge, compared with stays lasting one to five days (odds ratio 1.32 (95% confidence interval 1.19 to 1.47)). These odds increased to 103% for stays longer than 14 days (2.03 (1.84 to 2.24)). Other risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management. The 30 day mortality rate after discharge was 4.5% for surgically treated patients and 10.7% for non-surgically treated patients. These findings might not be generalizable to populations in other US states or in other countries. The administrative claims data used could have been incomplete or include inaccurate coding of diagnoses and comorbid conditions. The database also did not include patient socioeconomic status, which could affect access to care to a greater extent in New York state than in European countries. Specific cause of death was not available because few autopsies are performed in this population.
By contrast with recent findings in Sweden, decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality in a US cohort in New York state. This could reflect critical system differences in the treatment of hip fractures between Europe and the USA.Funding, competing interests, data sharing University of Rochester grant from the Clinical Translational Science Institute for statistical analyses used in this work (National Institutes of Health (UL1 TR000042)) and the National Institutes of Health (K-08 AR060164-01A). No competing interests declared. Data may be obtained through SPARCS at https://www.health.ny.gov/statistics/sparcs/access/.
髋部骨折患者的住院时间会影响其出院后30天的死亡风险吗？
在一项回顾性队列研究中，利用来自纽约州全州规划与研究合作系统（SPARCS）的基于人群的登记数据，对2000年至2011年期间在纽约州因髋部骨折入院的188,208名患者进行了调查。患者年龄在50岁及以上，接受了手术或非手术治疗。主要结局指标是出院后30天的死亡率。
与住院1至5天的患者相比，髋部骨折患者住院11至14天会使出院后30天的死亡几率增加32%（优势比1.32（95%置信区间1.19至1.47））。住院时间超过14天的患者，这一几率增至103%（2.03（1.84至2.24））。与早期死亡相关的其他风险因素包括出院至临终关怀机构、高龄、转移性疾病和非手术治疗。手术治疗患者出院后30天死亡率为4.5%，非手术治疗患者为10.7%。这些发现可能不适用于美国其他州或其他国家的人群。所使用的行政索赔数据可能不完整，或包括诊断和合并症的编码不准确。该数据库也未包括患者的社会经济状况，而在纽约州，社会经济状况对获得医疗服务的影响可能比在欧洲国家更大。由于该人群中很少进行尸检，因此无法获得具体死因。
与瑞典最近的研究结果相反，在纽约州的一个美国队列中，髋部骨折患者住院时间缩短与早期死亡率降低相关。这可能反映了欧洲和美国在髋部骨折治疗方面关键的系统差异。
资金、利益冲突、数据共享 罗切斯特大学获得临床转化科学研究所的资助，用于本研究的统计分析（美国国立卫生研究院（UL1 TR000042））以及美国国立卫生研究院（K-08 AR060164-01A）。未声明存在利益冲突。数据可通过SPARCS在https://www.health.ny.gov/statistics/sparcs/access/获取。
