Department of Family Medicine, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea.
Clinical Research Center, Asan Medical Center, 88, 43-gil Olympic-ro, Songpa-gu, Seoul, South Korea.
Osteoporos Int. 2019 Jan;30(1):145-153. doi: 10.1007/s00198-018-4747-7. Epub 2018 Oct 25.
There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.
The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old.
We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge.
A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21-30, 31-40, and 11-20 days groups, respectively (p value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14-2.12) against the reference group (11-20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals.
Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.
本研究旨在分析髋部骨折后住院时间与 65 岁以上老年人 1 年死亡率之间的关系。
我们使用韩国国家健康保险服务数据进行了一项回顾性队列研究，以确定 2007 年至 2009 年间 487460 名 65 岁以上出院后接受髋部骨折手术的患者。将髋部骨折手术的住院时间间隔为 10 天进行分类，并根据出院后 1 年的死亡率进行分析。
共有 4213 例患者接受髋部骨折手术后出院，其中 604 例（14.3%）在出院后 1 年内死亡。平均住院时间为 30.7 天（标准差 24.5 天）。住院时间≤10 天组的 1 年死亡率最高，为 21.7%，其次为 15.2%、14.3%、13.3%和 12.4%，分别为>40、21-30、31-40 和 11-20 天组（p 值<0.05）。在 Cox 比例风险回归中，与参考组（11-20 天）相比，住院时间≤10 天组的调整后危险比为 1.56（95%置信区间 1.14-2.12），而其他组没有统计学意义。死亡风险增加与年龄较大、男性、Charlson 合并症指数≥3、转子下骨折以及向三级和长期护理医院出院有关。
髋部骨折手术后 10 天内出院的老年人出院后 1 年死亡率较高。
