Hospitalizations After Hip Fractures

Hip fracture patients who are discharged from the hospital before they have fully stabilized stand a much higher risk of dying — even if they are discharged to another health care facility.

According to researchers publishing in the Archives of Internal Medicine, patients suffering from even one unresolved medical issue, such as a fever, breathing problem, infection, incontinence, or eating problem, have a 360-percent higher mortality rate and a 60-percent greater chance of being readmitted to the hospital.

Hip fractures are a major cause of death and disability among the elderly. About 350,000 people have the fractures every year, and medical complications are high. Despite the risks, however, doctors are under increasing pressure to reduce the number of days these patients stay in the hospital. Average stays for hip fracture patients have declined from about 20 days in 1981 to just 6.5 days in 1999.

In this study, investigators from Mount Sinai School of Medicine reviewed 559 cases of hip fracture patients from four hospitals in the New York area. All were treated and discharged in 1997 and 1998. Nearly 17 percent of the patients were found to have one or more “acute medical issues” and about 40 percent had one or more “new impairment” prior to discharge, which put them at higher risk for death and subsequent readmission to the hospital. The higher death rates and hospital readmission rates were seen in patients regardless if they were discharged to their homes or to a rehabilitation hospital or skilled nursing facility.

The authors believe these findings suggest a need for doctors to more carefully factor in the presence of unresolved medical issues when deciding when a hip fracture patient is ready to be discharged from the hospital. They also believe physicians need to work more closely with post-acute care facilities to ensure any unresolved medical issues are adequately addressed in the new setting.