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Keywords:

  • hip fractures;
  • patient readmission;
  • mortality;
  • disability

OBJECTIVES:  To examine the causes of hospital readmission after hip fracture and the relationships between hospital readmission and 6-month physical function and mortality.

DESIGN:   Prospective, multisite, observational cohort study.

SETTING:   Four hospitals in the New York City metropolitan area.

PARTICIPANTS:   Five hundred sixty-two patients hospitalized for hip fracture aged 50 and older and discharged alive in 1997–1998.

MEASUREMENTS:   Patient demographic characteristics, type of fracture and repair, comorbid conditions, postoperative complications, do not resuscitate status, and active clinical problems at the time of hospital discharge. Prefracture and 6-month mobility were measured using the Functional Independence Measure. Hospital readmissions and International Classification of Diseases, Ninth Revision principal diagnoses were ascertained from hospital admission/discharge databases, the New York Statewide Planning and Research Cooperative System, medical record review, and patient self-report.

RESULTS:   Eighty-two percent of participants were women, and 93% were white. Within 6 months after hospital discharge, 178 (32%) patients were readmitted to the hospital, with 45 (8%) readmitted more than once. Forty-seven of 233 readmissions (20%) occurred within the first 2 weeks after discharge, and 80 (34%) occurred within 4 weeks. Over 6 months, 89% of readmissions were for nonsurgical problems, of which infectious (21%) and cardiac (12%) diseases were the most common. In multivariate analyses, patients who were readmitted were more likely to require total assistance with ambulation at 6 months (odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6–4.6) and to die (OR = 4.0, 95% CI = 2.2–7.3) than those not readmitted.

CONCLUSION:   Hospital readmissions after hip fracture are largely due to nonsurgical illness and are associated with increased morbidity and mortality.