The risk of death after hip fracture is higher for patients in small- and medium-sized hospitals than in teaching hospitals in Canada, Faculty of Medicine researchers found.
There are 30,000 hip fractures reported in Canada every year, and about 1 of 10 patients die in hospital. In this study, published in the CMAJ (Canadian Medical Association Journal), UBC researchers examined whether the location where patients undergo treatment for hip fractures may influence their chance of survival.
The researchers looked at data on all patients aged 65 years or older who were hospitalized for a first hip fracture (168,340) between January 2004 and December 2012. Members of the Association of Canadian Academic Healthcare Organizations were classified as teaching hospitals; all other hospitals were community hospitals grouped by the number of beds. Large hospitals had 200 or more beds; medium, 50 to 199 beds; and small, less than 50 beds.
The researchers found that for every 1000 patients admitted to hospital with hip fracture, 14 more die at medium community hospitals and 43 more at small community hospitals than those admitted to teaching hospitals. For every 1,000 patients who undergo surgery to repair their hip fracture, 11 more die at medium community hospitals than at teaching hospitals.
Katie Sheehan
“In the elderly, hip fractures occur as frequently as common cancers but with severely worse outcomes,” said Katie Sheehan, a postdoctoral fellow in the School of Population and Public Health. “Even after treatment, 30 per cent die within a year, 25 per cent never walk again and 22 per cent never live independently. These figures have not changed in the past 15 years, and qualify hip fractures as a major health care issue in Canada.”
These findings support previous research that found a higher risk of death after hip fracture for patients treated at community hospitals and those with fewer available beds.
Most patients undergo surgery to repair their hip fracture. The risk of death after surgery was higher at medium community hospitals than at teaching hospitals. The higher risk may be a result of less timely care owing to fewer beds or staff or available equipment at medium community hospitals. Whether additional resources for medium community hospitals may improve survival in these vulnerable patients requires further investigation.
A small proportion of patients did not undergo surgery. These patients were also at higher risk of death when admitted to medium and small community hospitals than those admitted to teaching hospitals, perhaps because of a need to transfer them for surgery.