Abstract
Abstract
Background
Rates of emergency readmission within 30-days of discharge vary between hospitals, and are widely used as a marker of poor outcome. However, the factors associated with this are incompletely understood. This study aimed to investigate patient, medical, and surgical factors associated with 30-day readmission following hip fracture at an urban trust in the West Midlands, England.
Methods
In a retrospective observational cohort study of people aged ≥65 years presenting to a large hospital trust in England (2019-24) we used Chi-squared or Fisher’s exact tests for categorical variables, and Kruskal–Wallis tests for continuous variables to understand univariable associations with 30-day readmission. We also investigated patient‑level, medical, and surgical factors associated with 30‑day readmission tested using multivariable logistic regression.
Results
Of 5,999 patients with hip fracture over 5 years, 5,524 (92%) survived to discharge; 1,079 (19.5%) of whom were readmitted within 30-days. Half (51%) were readmitted under medical specialties, and only 5% to trauma and orthopaedics. Pneumonia was the commonest reason (629 patients; 58%). After adjusting for relevant covariates, several factors remained independently associated with readmission. Men were 30% more likely to be readmitted (OR 1.28; 95% CI 1.11-1.49). A very similar increase in risk was seen for: white patients compared with unknown ethnicity as coded (OR 1.33, 95% CI 1.08–1.67, p = 0.011); those with severe frailty (using Hospital Electronic Record Frailty Index) (OR 1.3, p=0.007); cardiac disease (congestive heart failure (OR 1.39, 95% CI 1.16–1.67, p < 0.001) and cardiac arrhythmias (OR 1.22, 95% CI 1.05–1.42, p = 0.009), and low serum albumin (OR 1.29 CI 1.12–1.48 p<0.001).
Conclusions
Most readmissions were for medical reasons, and this is reflected by the association between readmission and markers of frailty and cardiac disease. The ‘surgical’ factors associated with readmission may themselves be reflections of patient frailty. Early identification of high-risk patients and robust discharge planning may avoid readmissions, but our results do not support hip fracture registries using 30-day readmissions as a marker of surgical care quality.