Can We Predict 30-Day Readmission After Hip Fracture?

OBJECTIVES

To determine the most common reason for 30-day readmission after hospitalization for hip fractures.

DESIGN

A retrospective review.

SETTING

Single academic medical center that includes a Level 1 trauma center.

PATIENT SELECTION CRITERIA: Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients who died during their initial admission were excluded.

OUTCOME MEASURES AND COMPARISONS: Patient demographics, hospital quality measures, outcomes, and readmission within 30 days after discharge for each patient were reviewed. Thirty-day readmission reason was recorded and correlation analysis was performed.

RESULTS

A total of 3032 patients were identified with a mean age of 82.1 years and 70.5% of patients being women. The 30-day readmission cohort was 2.6 years older ( P < 0.001) and 8.8% more male patients ( P = 0.027), had 0.5 higher Charleston comorbidity index ( P < 0.001), 0.3 higher American Society of Anesthesiologists class ( P < 0.001), and were 9.2% less independent at the time of admission ( P = 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared with closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, P < 0.001). Those readmitted by 30 days developed more major (16.7% vs. 8.0%; P < 0.001) and minor (50.5% vs. 36.4%; P < 0.001) complications during their initial hospitalization and had a 1.5-day longer length of stay during their first admission ( P < 0.001). Those discharged home were less likely to be readmitted within 30 days (20.7% vs. 27.6%, P = 0.008). Multivariate regression revealed increasing American Society of Anesthesiologists class (odds ratio 1.47, P = 0.002) and preinjury ambulatory status (odds ratio 1.42, P = 0.007) was most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, chronic obstructive pulmonary disease exacerbation, and pneumonia.

CONCLUSIONS

Thirty-day readmission after hip fracture was associated with older, sicker patients with decreased preinjury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission after hip fracture was pulmonary complications.

LEVEL OF EVIDENCE: Prognostic Level III. See instructions for authors for a complete description of levels of evidence.