Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities
Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities
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DOI：
10.1186/s12913-015-0697-3
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发表时间：
2015-01-22
影响因子：
2.8
通讯作者：
Cumming, Robert G.
中科院分区：
文献类型：
--
作者：
Ireland, Anthony W.;Kelly, Patrick J.;Cumming, Robert G.
背景：髋部骨折的医院治疗是复杂的，通常包括急性骨科的连续发作、康复和意外情况的护理。大多数关于住院时间(LOS)的报告只涉及急性期护理。这项研究确定了在总住院时间内发生事件的频率和平均持续时间，并测量了患者水平和临床服务变量对急性期和总损失的影响。方法：联系2008年7月1日至2009年6月30日住院的2552名患者的管理数据集。结果：平均总LOS为30.8天，其中43%归因于急性骨折治疗，37%归因于康复治疗，20%归因于应急条件管理。社区患者未调整的总LOS为35.4d，而RAC患者为18.8d(p<；0.001)。转入康复的比例(57%比17%，p<；0.001)是造成这一差异的主要决定因素。在多因素分析中，在一个或多个住院阶段，新的RAC放置，出院到其他设施，以及压疮、尿路或手术部位感染的并发症使LOS增加至少4天。结论：骨折前居住地、康复选择、出院目的地和特定的并发症是急性期和总LOS的关键决定因素。计算LOS的特定决定因素的维度可能会确定针对性干预措施的潜在效率，例如正畸护理模型。
Background: Hospital treatment for hip fracture is complex, often involving sequential episodes for acute orthopaedics, rehabilitation and care of contingent conditions. Most reports of hospital length of stay (LOS) address only the acute phase of care. This study identifies the frequency and mean duration of the component episodes within total hospital stay, and measures the impacts of patient-level and clinical service variables upon both acute phase and total LOS.Methods: Administrative datasets for 2552 subjects hospitalised between 1 July 2008 and 30 June 2009 were linked. Associations between LOS, pre-fracture accommodation status, age, sex, fracture type, hospital separation codes, selected comorbidities and complications were examined in regression models for acute phase and total LOS for patients from residential aged care (RAC) and from the community.Results: Mean total LOS was 30.8 days, with 43 per cent attributable to acute fracture management, 37 per cent to rehabilitation and 20 per cent to management of contingent conditions. Community patients had unadjusted total LOS of 35.4 days compared with 18.8 days for RAC patients (p < 0.001). The proportion of transfers into rehabilitation (57 per cent vs 17 per cent, p < 0.001) was the major determinant for this difference. In multivariate analyses, new RAC placement, discharge to other facilities, and complications of pressure ulcer, urinary or surgical site infections increased LOS by at least four days in one or more phases of hospital stay.Conclusion: Pre-fracture residence, selection for rehabilitation, discharge destination and specific complications are key determinants for acute phase and total LOS. Calculating the dimensions of specific determinants for LOS may identify potential efficiencies from targeted interventions such as orthogeriatric care models.