Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h696 (Published 20 February 2015) Cite this as: BMJ 2015;350:h696
- Peter Nordström, professor1,
- Yngve Gustafson, professor1,
- Karl Michaëlsson, professor2,
- Anna Nordström, associate professor3
- 1Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, SE-910 87 Umeå, Sweden
- 2Department of Surgical Sciences, Section of Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
- 3Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå
- Correspondence to: P Nordström peter.nordstrom{at}germed.umu.se
- Accepted 5 January 2015
Abstract
Objective To investigate relation between inpatient length of stay after hip fracture and risk of death after hospital discharge.
Setting Population ≥50 years old living in Sweden as of 31 December 2005 with a first hip fracture the years 2006-12.
Participants 116 111 patients with an incident hip fracture from a closed nationwide cohort.
Main outcome measure Death within 30 days of hospital discharge in relation to hospital length of stay after adjustment for multiple covariates.
Results Mean inpatient length of stay after a hip fracture decreased from 14.2 days in 2006 to 11.6 days in 2012 (P<0.001). The association between length of stay and risk of death after discharge was non-linear (P<0.001), with a threshold for this non-linear effect of about 10 days. Thus, for patients with length of stay of ≤10 days (n=59 154), each 1-day reduction in length of stay increased the odds of death within 30 days of discharge by 8% in 2006 (odds ratio 1.08 (95% confidence interval 1.04 to 1.12)), which increased to16% in 2012 (odds ratio 1.16 (1.12 to 1.20)). In contrast, for patients with a length of stay of ≥11 days (n=56 957), a 1-day reduction in length of stay was not associated with an increased risk of death after discharge during any of the years of follow up.
Limitations No accurate evaluation of the underlying cause of death could be performed.
Conclusion Shorter length of stay in hospital after hip fracture is associated with increased risk of death after hospital discharge, but only among patients with length of stay of 10 days or less. This association remained robust over consecutive years.
Footnotes
Contributors: KM and PN contributed equally to the paper. PN conceived the idea for the study. PN compiled and analyzed the study estimates with the help and input of AN and KM. PN made initial drafts of tables and figures with input from all other authors. PN led the writing of the paper with contributions from all other authors.
Funding: The present study was funded by the Swedish research council. The researchers conducted this study totally independent of the funding bodies.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical considerations: This study was approved by the regional ethics board in Umeå and by the National Board of Health and Welfare in Sweden.
Data sharing: No additional data available.
Transparency: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.