Crijns Tom J, Caton Tyler, Teunis Teun, Davis Jacob T, McWilliam-Ross Kindra, Ring David, Sanchez Hugo B
Research performed at the Dell Medical School, Austin, Texas, USA.
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Texas, USA.
Arch Bone Jt Surg. 2018 Nov;6(6):492-500.
Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity, mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and can lower reimbursement. A better understanding of the patient and treatment characteristics associated with readmission may help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay is not associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of a proximal femur fracture, accounting for discharge destination and other factors.
We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admitted for treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regression models were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score (ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.
In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with a lower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASA class 3, 4 and 5.
The observation that patients cared for by specific surgeons are more likely to experience readmission within one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify and disseminate best practices might reduce readmission rates.
III.
股骨近端骨折在老年人中很常见，与高发病率、死亡率及早期再入院相关。早期再入院作为衡量医院护理质量的一项指标正日益受到关注，且可降低报销费用。更好地了解与再入院相关的患者及治疗特征可能有助于改进项目举措。本研究检验了主要原假设，即在考虑出院目的地及其他因素的情况下，股骨近端骨折手术治疗患者的住院时间与30天内及1年内较高的再入院率无关。
我们对一家城市二级创伤中心收治的1061例年龄55岁及以上的成年股骨近端骨折患者的数据库进行了二次分析。创建了多变量逻辑回归和线性回归模型，以考虑年龄、性别、种族、体重指数、美国麻醉医师协会评分（ASA）、骨折类型（AO/OTA）、固定类型、手术医生、手术时长及出院目的地的影响。
在多变量逻辑回归分析中，由外科医生4进行治疗与较低的30天再入院率独立相关。较高的1年再入院率与较长的住院时间、ASA 3级、4级和5级相关。
特定外科医生治疗的患者在股骨近端骨折手术后1年内更有可能再次入院，这一观察结果表明，识别和推广最佳实践的项目改进措施可能会降低再入院率。
III级。
