title: Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes.
abstract: OBJECTIVE
  To examine the causes of hospital readmission after hip fracture and the relationships between hospital readmission and 6-month physical function and mortality.
  
  
  METHODS
  Prospective, multisite, observational cohort study.
  
  
  METHODS
  Four hospitals in the New York City metropolitan area.
  
  
  METHODS
  Five hundred sixty-two patients hospitalized for hip fracture aged 50 and older and discharged alive in 1997-1998.
  
  
  METHODS
  Patient demographic characteristics, type of fracture and repair, comorbid conditions, postoperative complications, do not resuscitate status, and active clinical problems at the time of hospital discharge. Prefracture and 6-month mobility were measured using the Functional Independence Measure. Hospital readmissions and International Classification of Diseases, Ninth Revision principal diagnoses were ascertained from hospital admission/discharge databases, the New York Statewide Planning and Research Cooperative System, medical record review, and patient self-report.
  
  
  RESULTS
  Eighty-two percent of participants were women, and 93% were white. Within 6 months after hospital discharge, 178 (32%) patients were readmitted to the hospital, with 45 (8%) readmitted more than once. Forty-seven of 233 readmissions (20%) occurred within the first 2 weeks after discharge, and 80 (34%) occurred within 4 weeks. Over 6 months, 89% of readmissions were for nonsurgical problems, of which infectious (21%) and cardiac (12%) diseases were the most common. In multivariate analyses, patients who were readmitted were more likely to require total assistance with ambulation at 6 months (odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6) and to die (OR = 4.0, 95% CI = 2.2-7.3) than those not readmitted.
  
  
  CONCLUSIONS
  Hospital readmissions after hip fracture are largely due to nonsurgical illness and are associated with increased morbidity and mortality.
authors.affiliation: Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1070, New York, NY 10029, USA. kenneth.boockvar@mssm.edu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Ann
authors.initials: A
authors.lastname: Litke
authors.forename: Stacey B
authors.initials: SB
authors.lastname: Silberzweig
authors.forename: MaryAnn
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Joan D
authors.initials: JD
authors.lastname: Penrod
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.forename: Kenneth
authors.initials: K
authors.lastname: Koval
authors.forename: Elton
authors.initials: E
authors.lastname: Strauss
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D014600:Utilization Review