Ali Adam M, Gibbons Charles E R
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
Injury. 2017 Feb;48(2):243-252. doi: 10.1016/j.injury.2017.01.005. Epub 2017 Jan 3.
Early readmission to hospital after hip fracture is associated with increased mortality and significant costs to the healthcare system. There is growing interest in the use of 30-day readmission rates as a metric of hospital performance. Identifying patients at increased risk of readmission after hip fracture may enable pre-emptive action to mitigate this risk and the development of effective methods of risk-adjustment to allow readmission to be used as a reliable measure of hospital performance.
We conducted a systematic review of bibliographic databases and reference lists up to July 2016 to identify primary research papers assessing the effect of patient- and hospital-related risk factors for 30-day readmission to hospital after hip fracture.
495 papers were found through electronic and reference search. 65 full papers were assessed for eligibility. 22 met inclusion criteria and were included in the final review. Medical causes of readmission were significantly more common than surgical causes, with pneumonia consistently being cited as the most common readmission diagnosis. Age, pre-existing pulmonary disease and neurological disorders were strong independent predictors of readmission. ASA grade and functional status were more robust predictors of readmission than the Charlson score or individual co-morbidities. Hospital-related risk factors including initial length of stay, hospital size and volume, time to surgery and type of anaesthesia did not have a consistent effect on readmission risk. Discharge location and the strength of hospital-discharge facility linkage were important determinants of risk.
Patient-related risk factors such as age, co-morbidities and functional status are stronger predictors of 30-day readmission risk after hip fracture than hospital-related factors. Rates of 30-day readmission may not be a valid reflection of hospital performance unless a clear distinction can be made between modifiable and non-modifiable risk factors. We identify a number of deficiencies in the existing literature and highlight key areas for future research.
髋部骨折后早期再次入院与死亡率增加及医疗系统的高额费用相关。将30天再入院率作为医院绩效指标的关注度日益提高。识别髋部骨折后再入院风险增加的患者，可能有助于采取预防措施以降低这种风险，并开发有效的风险调整方法，使再入院率能够作为衡量医院绩效的可靠指标。
我们对截至2016年7月的文献数据库和参考文献列表进行了系统综述，以识别评估患者及医院相关风险因素对髋部骨折后30天再入院影响的原始研究论文。
通过电子检索和参考文献检索共找到495篇论文。对65篇全文进行了资格评估。22篇符合纳入标准并被纳入最终综述。再次入院的医学原因比手术原因更为常见，肺炎一直被列为最常见的再入院诊断。年龄、既往肺部疾病和神经系统疾病是再入院的强有力独立预测因素。美国麻醉医师协会（ASA）分级和功能状态比Charlson评分或个体合并症更能可靠地预测再入院。包括初始住院时间、医院规模和数量、手术时间和麻醉类型在内的医院相关风险因素对再入院风险的影响并不一致。出院地点和医院与出院机构联系的紧密程度是风险的重要决定因素。
年龄、合并症和功能状态等患者相关风险因素比医院相关因素更能有力地预测髋部骨折后30天再入院风险。除非能够明确区分可改变和不可改变的风险因素，否则30天再入院率可能无法有效反映医院绩效。我们识别了现有文献中的一些不足之处，并突出了未来研究的关键领域。
