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Aging and disease    2017, Vol. 8 Issue (4) : 402-409     DOI: 10.14336/AD.2016.1228
Original Article |
One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan
Lee Tien-Ching1,2,8, Ho Pei-Shan4, Lin Hui-Tzu5, Ho Mei-Ling1,6,7, Huang Hsuan-Ti3,7, Chang Je-Ken1,3,7,*
1Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital
2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital
3Department of Orthopaedics, Kaohsiung Medical University Hospital
4Faculty of Dental Hygiene, College of Dental Medicine
5Center of Teaching and Research, Kaohsiung Municipal Ta-Tung Hospital
6Department of Physiology, College of Medicine
7Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital
8Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract  

Early readmission following hip fracture (HFx) is associated with high morbidity and mortality. We conducted a survival analysis of patients with readmission within 1 year after HFx to elucidate the trend and predictors for readmission. We used Taiwan National Health Insurance Database to recruit HFx patients who underwent operations between 2000 and 2009. Patients < 60 years; with pathological fractures; involved in major traffic accidents; with previous pelvis, femur, and hip operations; or who died during the index admission were excluded. We used the Chi-square test, logistic regression, Kaplan-Meier method, and Cox proportional hazards model to analyze variables, including age, gender, hospital stay duration, index admission time, and comorbidity on readmission. 5,442 subjects (61.2% female) met the criteria with mean age of 78.8 years. Approximately 15% and 43% HFx patients were readmitted within 30 days (early) and between 30 days and 1 year (late) after discharge, respectively. Highest readmission incidence was observed within the first 30 days. Most common causes of readmission in early and late groups were respiratory system diseases and injuries, respectively. Cox model showed male, old age, hospital stay > 9 days, Charlson Comorbidity Index ≥ 1, index admission during 2000–2003, and internal fixation of HFx were independent predictors of readmission. One-year mortality of the early and the late readmission groups was 44.9% and 32.3%, much higher than overall mortality which was 16.8%. Predictive factors for readmission within 1 year included male, old age, comorbidities, and longer hospital stay. One-year mortality in readmitted patients was significantly higher. HFx patients with these factors need careful follow-up, especially within 30 days after discharge.

Keywords Readmission      hip fractures      mortality      urvival analysis      Taiwanese population     
Corresponding Authors: Chang Je-Ken   
About author:

these authors equally contributed to this work

Issue Date: 01 August 2017
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Lee Tien-Ching
Ho Pei-Shan
Lin Hui-Tzu
Ho Mei-Ling
Huang Hsuan-Ti
Chang Je-Ken
Cite this article:   
Lee Tien-Ching,Ho Pei-Shan,Lin Hui-Tzu, et al. One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan[J]. Aging and disease, 2017, 8(4): 402-409.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2016.1228     OR     http://www.aginganddisease.org/EN/Y2017/V8/I4/402
Early readmissionLate readmission

YesNoYesNo
GenderN%N%P valueN%N%P value
 Female42712.82290587.18<0.0001130339.11202960.89<0.0001
 Male39018.49171981.51105149.83105850.17
Age (years)
 60-69759.4272190.58<0.000123629.6556070.35<0.0001
 70-7931814.67184985.3389741.39127058.61
 ≥8042417.1205582.9122149.25125850.75
Time of admission
 2000-200330514.83175285.170.005889143.32116681.04<0.0001
 2004-200621813.55139186.4564940.3496082.91
 2007-200920111.32157588.6860634.12117086.09
Hospital stay
 ≤9 days36211.72272888.28<0.0001118438.32190661.68<0.0001
 >9 days45519.35189780.65117049.74118250.26
CCI
 029811.74224088.26<0.000181932.27171967.73<0.0001
 113317.961082.140254.134145.9
 217316.7885883.2250649.0852550.92
 38918.2439981.7626053.2822846.72
 4+12419.3151880.6936757.1727542.83
Operation
 Art30013.24196686.760.00291640.42135059.580.0004
 Fix51716.28265983.72143845.28173854.72
Table 1  Demographics of Early and Late Readmission Groups.
Early readmissionLate readmission

HRR95%CIP valueHRR95%CIP value
GenderFemale
Male1.461.27,1.68<0.00011.381.27,1.5<0.0001
Age (years)60-69
70-791.611.26,2.080.00011.51.31,1.74<0.0001
≥801.911.5,2.46<0.00011.931.68,2.22<0.0001
Time of admission2000-2003
2004-20060.850.72,1.010.06010.910.82,10.053
2007-20090.740.63,0.880.00050.790.71,0.87<0.0001
Hospital stay≤9 days
>9 days1.671.45,1.92<.00011.391.28,1.51<0.0001
CCI0
11.41.14,1.720.00161.741.54,1.96<0.0001
21.411.17,1.70.00041.661.48,1.85<0.0001
31.451.14,1.830.00291.761.53,2.03<0.0001
4+1.681.35,2.06<0.00012.121.87,2.4<0.0001
OperationArt
Fix1.251.08,1.440.00251.141.05,1.240.0026
Table 2  Cox Proportional Hazards Regression Model of Early and Late Readmission Groups.
Figure 1.  Kaplan-Meier curve showing the time to readmission over the first year following initial discharge after operation for hip fractures

A) Kaplan-Meier curves by gender (M: male; F: female). B) Kaplan-Meier curves by age. C) Kaplan-Meier curves by the three-study periods of index admission for hip fractures. D) Kaplan-Meier curves by the length of hospital stay. E) Kaplan-Meier curves by Charlson Comorbidity Index (CCI). F) Kaplan-Meier curves by operation type (Art: Arthroplasty; Fix: Internal fixation).

Figure 2.  Distribution of readmission causes in different time periods within 1 year using International Classification of Diseases, Version 9, Clinical Modification (ICD-9-CM) coding

001-139: Infectious and parasitic diseases; 140-239: Neoplasms; 240-279: Endocrine, nutritional and metabolic diseases, and immunity disorders; 280-289: Diseases of the blood and blood-forming organs; 290-319: Mental disorders; 320-389: Diseases of the nervous system and sense organs; 390-459: Diseases of the circulatory system; 460-519: Diseases of the respiratory system; 520-579: Diseases of the digestive system; 580-629: Diseases of the genitourinary system; 630-679: Complications of pregnancy, childbirth, and the puerperium; 680-709: Diseases of the skin and subcutaneous tissue; 710-739: Diseases of the musculoskeletal system and connective tissue; 740-759: Congenital anomalies;760-779: Certain conditions originating in the perinatal period.

Time of readmissionMortality within one year
 Yes No
<=30dayN%N%P value
 Yes32544.8939955.11P<0.0001
 No58712.44413187.56
<=90day
 Yes49540.9871359.02P<0.0001
 No4179.85381790.15
<=180day
 Yes60536.98103163.02P<0.0001
 No3078.07349991.93
<=365day
 Yes69332.29145367.71P<0.0001
 No2196.64307793.36
Table 3  One-year mortality rate at different time of readmission.
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