Longer Length of Stay Increases 1-year Readmission Rate in Patients Undergoing Hip Fracture Surgery

Background: Proximal femur fractures are prevalent among the elderly and associated with substantial morbidity,mortality, and early readmission. Early readmission is gaining popularity as a measure of quality of hospital care and canlower reimbursement. A better understanding of the patient and treatment characteristics associated with readmissionmay help inform program improvement initiatives. This study tested the primary null hypothesis that length of stay isnot associated with higher rates of readmission within 30 days and 1 year in patients having operative treatment of aproximal femur fracture, accounting for discharge destination and other factors.Methods: We performed a secondary analysis on a database of 1,061 adult patients, age 55 years or older, admittedfor treatment of a proximal femoral fracture in an urban level 2 trauma center. Multivariable logistic and linear regressionmodels were created to account for the influence of age, sex, race, BMI, American Society of Anesthesiologists score(ASA), fracture type (AO/OTA), fixation type, operating surgeon, operative duration, and discharge destination.Results: In multivariable logistic regression analysis, treatment by surgeon 4 was independently associated with alower 30-day readmission rate. Higher one-year readmission rate was associated with a longer length of stay, ASAclass 3, 4 and 5.Conclusion: The observation that patients cared for by specific surgeons are more likely to experience readmissionwithin one year of surgery for a fracture of the proximal femur, suggests that program improvements to identify anddisseminate best practices might reduce readmission rates.Level of evidence: III