Hospital type is an indicator for structures and processes of care. The effect of hospital type on hip fracture in-hospital mortality is unknown. We determine whether hip fracture in-hospital mortality differs according to hospital type. We retrieved records of hip fracture for 167,816 patients aged 65 years and older, who were admitted to a Canadian acute hospital between 2004 and 2012. For each hospital type we measured and compared the cumulative incidence of in-hospital death by in-patient day, accounting for discharge as a competing event. The cumulative incidence of in-hospital death at in-patient day 30 was lowest for teaching hospital admissions (7.3%) and highest for small community hospital admissions (11.5%). The adjusted odds of in-hospital death were 12% (95% CI 1.06–1.19), 25% (95% CI 1.17–1.34), and 64% (95% CI 1.50–1.79) higher for large, medium, and small community hospital versus teaching hospital admissions. The adjusted odds of nonoperative death were 1.6 times (95% CI 1.42–1.86), and 3.4 times (95% CI 2.96–3.94) higher for medium and small community hospital versus teaching hospital admissions. The adjusted odds of postoperative death were 14% (95% CI 1.07–1.22) and 20% (95% CI 1.10–1.31) higher at large and medium community hospitals versus teaching hospitals. The adjusted odds of postoperative death were largest at small community hospitals but the confidence interval crossed 1 (OR = 1.25, 95% CI 0.92–1.70). A higher proportion of hip fracture patients die at non-teaching compared to teaching hospitals accounting for length of stay. Higher mortality at small community hospitals may reflect disparities in access to resources and delay to treatment.
The prevention of a subsequent, contralateral hip fracture is targeted as an avoidable event in the elderly. Fall prevention and bone strengthening measures have met with limited success and the urgency of their effect is undetermined. Our objective was to evaluate the time to second hip fracture (the time between a first and a subsequent, contralateral fracture) in elderly patients, using a population-based administrative health data set. The 58,286 records of persons older than 60 yrs and hospitalized for a hip fracture between 1985 and 2005 were obtained from a Provincial administrative health database. We excluded non-traumatic cases and identified the care episodes related to a subsequent hip fracture for each patient using unique identifiers. We used a 5 year “wash-out period” to avoid counting a second fracture as a first one. We calculated the proportion of first and second fractures and sex distribution over time (fiscal years) and quantified the time between first and second fracture, while correlating it to age, sex and fracture type.Purpose
Method
To determine whether there have been changes in the age, sex and subtype specific first hip fracture rates in Canadian province of British Columbia (BC) between 1990 and 2004. Records of all persons aged 60 years and older hospitalized with hip fractures in BC between 1985 and 2004 were obtained from the Canadian Institute for Health Information Discharge Abstract Database. Only the first hip fracture records were included, and fractures likely due to causes other than trauma were excluded. Age- and sex-specific rates were calculated using population denominators from Statistics Canada and direct standardization was used. Age standardized rates allowed for comparison across years with adjustment for age distribution.Purpose
Method
This prospective cohort study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life. It included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at surgical consultation time (baseline) and one year post-operation. Baseline WOMAC score was a significant predictor for follow-up WOMAC score. Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation. This study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life. Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation. The odds of a “better than expected” functional outcome decreased by 8% for each additional month on the wait list. The study provides the estimates of decreased probability of “better than expected” outcome given a prolonged waiting time. Our study indicates that timely access to THA is needed for optimal post-operative outcome. Baseline WOMAC score was a significant predictor for the follow-up WOMAC score in function (p=0.0005), pain (p=0.0036), and stiffness (p= 0.0004). Waiting for six months or less doubled the odds of achieving a “better than expected” functional outcome compared to longer waits (p= 0.05). This prospective cohort study included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at the surgical consultation time (baseline) and one year post operation. Regression models were used to determine the “expected” outcome for a certain individual baseline score. By using expected HRQOL outcome, we identified patients whose benefit from THA is better than expected. Logistic regression models were used to assess the relationship between waiting time and the probability of “better than expected” outcome.
