title: Is the higher mortality among men with hip fracture explained by sex-related differences in quality of in-hospital care? A population-based cohort study.
abstract: mortality after hip fracture is two-fold higher in men compared with women. It is unknown whether sex-related differences in the quality of in-hospital care contribute to the higher mortality among men.
  
  
  
  to examine sex-related differences in quality of in-hospital care, 30-day mortality, length of hospital stay and readmission among patients with hip fracture.
  
  
  
  population-based cohort study.
  
  
  
  using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 25,354 patients ≥65 years (29% were men). Outcome measures included quality of in-hospital care as reflected by seven process performance measures, 30-day mortality, length of stay (LOS) and readmission within 30 days after discharge. Data were analysed using multivariable regression techniques.
  
  
  
  in general, there were no substantial sex-related differences in quality of in-hospital care. The relative risk for receiving the individual process performance measure ranged from 0.91 (95% confidence interval (CI) 0.85-0.97) to 0.97 (95% CI 0.94-0.99) for men compared with women. The 30-day mortality was 15.9% for men and 9.3% for women corresponding to an adjusted odds ratio (OR) of 2.30 (95% CI 2.09-2.54). The overall readmission risk within 30 days after discharge was 21.6% for men and 16.4% for women (adjusted OR of 1.38 (95% CI 1.29-1.47)). No difference in LOS was observed between men and women.
  
  
  
  sex differences in the quality of in-hospital care appeared not to explain the higher mortality and risk of readmission among men hospitalised with hip fracture.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark.|Department of Orthopaedic Surgery, Horsens Region Hospital, Horsens 8700, Denmark.
authors.forename: Pia Kjær
authors.initials: PK
authors.lastname: Kristensen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark.
authors.forename: Anil
authors.initials: A
authors.lastname: Mor
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Theis Muncholm
authors.initials: TM
authors.lastname: Thillemann
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8200, Denmark.
authors.forename: Alma Becic
authors.initials: AB
authors.lastname: Pedersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D017064:Process Assessment, Health Care; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 30-day mortality; hip fracture; older people; quality of care; readmission; sex differences