title: Causes and predictors of early re-admission after surgery for a fracture of the hip.
abstract: The aim of this study was to examine the rates and potential risk factors for 28-day re-admission following a fracture of the hip at a high-volume tertiary care hospital. We retrospectively reviewed 467 consecutive patients with a fracture of the hip treated in the course of one year. Causes and risk factors for unplanned 28-day re-admissions were examined using univariate and multivariate analysis, including the difference in one-year mortality. A total of 55 patients (11.8%) were re-admitted within 28 days of discharge. The most common causes were pneumonia in 15 patients (27.3%), dehydration and renal dysfunction in ten (18.2%) and deteriorating mobility in ten (18.2%). A moderate correlation was found between chest infection during the initial admission and subsequent re-admission with pneumonia (r = 0.44, p < 0.001). A significantly higher mortality rate at one year was seen in the re-admission group (41.8% (23 of 55) vs. 18.7% (77 of 412), p < 0.001). Logistic regression analysis identified advancing age, admission source, and the comorbidities of diabetes and neurological disorders as the strongest predictors for re-admission. Early re-admission following hip fracture surgery is predominantly due to medical causes and is associated with higher one-year mortality. The risk factors for re-admission can have implications for performance-based pay initiatives in the NHS. Multidisciplinary management in reducing post-operative active clinical problems may reduce early re-admission.
authors.affiliation: Hull Royal Infirmary, Department of Trauma and Orthopaedics, Anlaby Road, Hull HU3 2JZ, UK. asim2002@yahoo.com
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: F S
authors.initials: FS
authors.lastname: Hossain
authors.forename: Z
authors.initials: Z
authors.lastname: Dashti
authors.forename: N
authors.initials: N
authors.lastname: Muthukumar
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006620:Hip Fractures / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors