OBJECTIVES

The study objective was to determine risk factors, incidence and time to event of readmissions and re-operations within 180 days of hip fracture treatment in a Canadian population.

METHODS

This retrospective observational cohort analysis used patient-level data, from the Discharge Abstract Database (2013Q2-2017Q1), accessed through IntelliHEALTH Ontario. Patients were 18 years of age or older, with a valid Health Card number, admitted as an inpatient to an Ontario hospital due to a hip fracture and treated with an internal fixation device or hip arthroplasty procedure. Outcomes of interest included incidence and timing of first readmission (all cause and hip-related) and hip-related reoperation. Multivariate modeling was used to examine patient risk factors (demographics and co-morbidities) and surgical interventions (internal fixation devices or arthroplasty) affecting the outcomes of interest.

RESULTS

A total of 28,448 patients were included in the analysis. The majority were female (70.2%) with a mean age 79.9 ± 12.3 years with the most common fixation method being plate/screw (32.0%), partial hip arthroplasty (28.2%), and intramedullary nail (24.9%). A total of 5903 (20.8%) patients were readmitted (all-cause), of which 1228 (26%) were hip related. The average time to an all-cause readmission was 66 ± 52 days. Among those with a hip-related readmission, 896 (73%) had a reoperation procedure of which 61% were fixed using arthroplasty. Multivariate analyses showed that with increasing age, the risk of an all-cause readmission increased but the risk of a hip-related readmission decreased, likely due to the competing nature of the readmissions. The odds of a female patient presenting with a hip related readmission was 59% higher than for male patients (OR 1.59, p <0.001).

CONCLUSIONS

This study in a Canadian population found large number of patients were readmitted and required re-operation post an index hip fracture operation with female patients presenting a significantly elevated odds of hip-related readmission.