Short Hospital Stays After Hip Fracture May Increase Risk Of Death

A new study published in The British Medical Journal (BMJ) finds that adults aged 50 and older who are subject to short-term hospital stays after admission for hip fractures may be at higher risk of death than those who have longer hospital stays.

Researchers found that hospital stays lasting less than 10 days after hip fracture was associated with increased risk of death.

Hip fractures are an increasingly common problem among older adults, with more than 95% of cases being caused by falls.

In 2010, there were around 258,000 hospital admissions in the USA for hip fractures among adults aged 65 and older. 

And according to the Centers for Disease Control and Prevention (CDC), the number of hip fracture-related hospital admissions is expected to rise in coming years along with the aging population.

These admissions put an enormous strain on health care services and costs. 

One-way health care systems have attempted to reduce this burden is by reducing the length of hospital stays for patients, referring them to home- or community-based care instead.

However, the researchers of this latest study - from Umeå University in Sweden - note that there are fewer sufficiently educated staff outside of hospital settings, and shorter hospital stays may mean the patient has less time for satisfactory rehabilitation.

These points raise the question: does early hospital discharge increase patients' risk of complications and death?

Patients at twice the risk of death with short-term hospital stays

To find out, the team assessed 116,111 Swedish patients aged 50 and older who had been admitted to the hospital for hip fractures between 2006 and 2012.

The researchers analyzed how long the patients stayed in hospital and calculated their risk of dying within 30 days after being discharged.

Between 2006 and 2012, the team found that the average length of stay in the hospital for hip fracture patients fell by around 20%, from 14.2 days to 11.6 days.

Compared with patients who stayed in the hospital for at least 15 days, those who stayed in the hospital for 5 days or less were twice as likely to die within 30 days of being discharged, according to the researchers.

In addition, the researchers found that for patients whose hospital stay lasted less than 10 days, each 1-day reduction in length of stay was associated with an 8% increased risk of death in the 30 days following discharge.

Male patients and those with pre-existing heart, lung or kidney disease were found to be at highest risk of death in the 30 days after discharge following short-term hospital stays.

Commenting on their findings, the researchers say:

"Our results suggest that the continuous efforts to decrease length of stay after major surgery in many countries is associated with higher mortality after hospital discharge.

In addition to evaluation of other diagnoses than hip fractures, further research should seek to gain a better understanding of the underlying cause of the increased risk of death after discharge in surgical patients, and evaluate whether early discharge to rehabilitation centers or nursing homes is associated with a worse outcome."

The researchers admit their findings are subject to some limitations. 

For example, following a hip fracture, risk of death is highest early on. This means that if a patient's length of hospital stay is reduced, they will automatically be at increased risk of death. "In the present study, this could bias the association between length of stay and death during follow-up as length of stay decreased," the authors note.

In addition, the researchers say they were unable to assess whether subjects received home- or community-based care following discharge, noting that it would be interesting to see whether one or the other may lead to a more positive outcome.

In an editorial linked to the study, another team of researchers at the University of Toronto in Canada - says these study results may "serve as further warning to those who seek to discharge patients as quickly as possible."

"As clinicians we should be aware that, although hospitals are scarce resources, rapid discharge of patients should be considered carefully," they add. 

"For some patients, early discharge is likely beneficial and for others perhaps not. As policy makers, we should be aware that, while we have the tools to reduce length of stay, the potential for unintended consequences should not be forgotten."

In February 2014, a different team of specialists reported on a study published in JAMA suggesting that home-based exercise programs may improve recovery for patients following hip fracture.

References:

1.  Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden, Peter Nordström, et al., BMJ, doi: 10.1136/bmj.h696, published online 24 February 2015.
2.  Length of hospital stay after hip fracture: how low can we go before patients are at risk?, Peter Cram, Raphael Philip Rush, BMJ, doi: 10.1136/bmj.h823, editorial.
3.  Additional source: CDC, Hip fractures among older adults, accessed 23 February 2015.