title: Time trends in hospital stay after hip fracture in Canada, 2004-2012: database study.
abstract: Changes in bed management and access policy aimed to shorten Canadian hip fracture hospital stay. Secular trends in hip fracture total, preoperative, and postoperative stay are unknown. Hip fracture stay shortened from 2004 to 2012, mostly from shortening postoperative stay. This may reflect changes in bed management rather than access policy.
  
  
  OBJECTIVE
  To compare the probability of discharge by time after patient admission to hospital with first-time hip fracture over a period of nine calendar years.
  
  
  METHODS
  We retrieved acute hospitalization records for 169,595 patients 65 years and older, who were admitted to an acute care hospital with hip fracture between 2004 and 2012 in Canada (outside of Quebec). The main outcome measure was cumulative incidence of discharge by inpatient day, accounting for competing events that end hospital stay.
  
  
  RESULTS
  The probability of surgical discharge within 30 days of admission increased from 57.2 % in 2004 to 67.3 % in 2012. The probability of undergoing surgery on day of admission or day after fluctuated around 58.5 % over the study period. For postoperative stay, the discharge probability increased from 6.8 to 12.2 % at day 4 after surgery and from 57.2 to 66.6 % at day 21 after surgery, between 2004 and 2012. The differences across years persisted after adjustment for characteristics of patients, fracture, comorbidity, treatment, type and timing of surgery, and access to care.
  
  
  CONCLUSIONS
  Hospital stay following hip fracture shortened substantially between 2004 and 2012 in Canada, mostly due to shortening of postoperative stays. Shorter hospital stays may reflect changes in bed management protocols rather than in access policy.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. boris.sobolev@ubc.ca.
authors.forename: Boris
authors.initials: B
authors.lastname: Sobolev
authors.affiliation: Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Guy
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. sheehakj@mail.ubc.ca.
authors.forename: Katie Jane
authors.initials: KJ
authors.lastname: Sheehan
authors.affiliation: Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kuramoto
authors.affiliation: Division of Orthopaedic Surgery and Center for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Bohm
authors.affiliation: Departments of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beaupre
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Sutherland
authors.affiliation: Division of Orthopaedic Surgery, Dalhousie University, Halifax, NS, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Dunbar
authors.affiliation: Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: Griesdale
authors.affiliation: Department of Medicine, McGill University, Montréal, QC, Canada.
authors.forename: Suzanne N
authors.initials: SN
authors.lastname: Morin
authors.affiliation: Division of Orthopaedic Surgery, McGill University, Montréal, QC, Canada.
authors.forename: Edward
authors.initials: E
authors.lastname: Harvey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D013997:Time Factors
keywords: Competing risks; Cumulative incidence; Hip fracture; Length of stay; Postoperative stay; Time trends