Nilsen Sara Marie, Bjørngaard Johan Håkon, Carlsen Fredrik, Anthun Kjartan Sarheim, Johnsen Lars Gunnar, Vatten Lars Johan, Asheim Andreas
Center for Health Care Improvement, Trondheim University Hospital, Trondheim, Norway.
Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Clin Epidemiol. 2020 Feb 19;12:173-182. doi: 10.2147/CLEP.S237060. eCollection 2020.
A reduction in the length of hospital stay may threaten patient safety. This study aimed to estimate the effect of organizational pressure to discharge on 60-day mortality among hip fracture patients.
In this cohort study, hip fracture patients were analyzed as if they were enrolled in a sequence of trials for discharge. A hospital's discharge tendency was defined as the proportion of patients with other acute conditions who were discharged on a given day. Because the hospital's tendency to discharge would affect hip fracture patients in an essentially random manner, this exposure could be regarded as analogous to being randomized to treatment in a clinical trial. The study population consisted of 59,971 Norwegian patients with hip fractures, hospitalized between 2008 and 2016, aged 70 years and older. To calculate the hospital discharge tendency for a given day, we used data from all 5,013,773 other acute hospitalizations in the study period.
The probability of discharge among hip fracture patients increased by 5.5 percentage points (95% confidence interval (CI)=5.3-5.7) per 10 percentage points increase in hospital discharges of patients with other acute conditions. The increased risk of death that could be attributed to a discharge from organizational causes was estimated to 3.7 percentage points (95% CI=1.4-6.0). The results remained stable under different time adjustments, follow-up periods, and age cut-offs.
This study showed that discharges from organizational causes may increase the risk of death among hip fracture patients.
缩短住院时间可能会威胁患者安全。本研究旨在评估组织性出院压力对髋部骨折患者60天死亡率的影响。
在这项队列研究中，将髋部骨折患者当作参加了一系列出院试验的对象进行分析。医院的出院倾向定义为在某一天出院的患有其他急性疾病的患者比例。由于医院的出院倾向会以基本随机的方式影响髋部骨折患者，这种暴露可被视为类似于在临床试验中被随机分配接受治疗。研究人群包括2008年至2016年间住院的59971名70岁及以上的挪威髋部骨折患者。为计算某一天的医院出院倾向，我们使用了研究期间所有5013773例其他急性住院病例的数据。
其他急性疾病患者的医院出院率每增加10个百分点，髋部骨折患者的出院概率就增加5.5个百分点（95%置信区间（CI）=5.3 - 5.7）。因组织性原因出院导致的死亡风险增加估计为3.7个百分点（95% CI = 1.4 - 6.0）。在不同的时间调整、随访期和年龄界限下，结果保持稳定。
本研究表明，因组织性原因出院可能会增加髋部骨折患者的死亡风险。
