Emergency Department Management of Hip Fractures: Factors Predicting Readmission at 30 day, 60 day, 90 day and 1 year Intervals
Author(s): Brian Begley, Francis Maguire, Tyler Hoskins, Justin M Miller, James C Wittig
Introduction: The incidence of hip fractures is increasing and will have increased to 6.3 million in 2050. Concurrently, emergency departments have been experiencing overcrowding. The purpose of the present study is to determine if a series of factors affected readmissions at 30 day, 60 day, 90 day, and 1 year intervals in hip fracture patients at five different hospital locations. The factors analyzed included: Number of hours between completion of triage care and entry into the operating room, the time of day the patient entered the operating room, the day of week the patient was discharged from hospital, ASA score, discharge disposition, and length of stay.
Methods: This was a retrospective study of patients with an admission from the Emergency Department to the Operating room for a hip or femoral fracture between January of 2018 and December of 2020. Patients were identified using a series of reports in Epic and HPM which listed the time the patient went to the operating room following completion of triage care, length of stay, and discharge disposition. Readmissions were counted at 30 days, 60 days, 90 days, and 1 year following discharge. Chi-square tests were performed to determine statistical significance and a p-value of <0.05 was deemed to be statistically significant.
Results: A total of 2308 patients were diagnosed with hip fractures who presented to the Emergency department to Atlantic Health System hospitals. Our findings indicated that being transferred to the operating room after 12 hours following completion of triage care does appear to have a statistically significant effect on 30 day readmissions (p=0.005) and entering the operating room after 24 hours does effect 90 day readmissions (p=0.014). Additionally, there was a significantly higher rate of readmission in patients who were discharged to a facility instead of home at all intervals. Further, higher ASA scores had a significant effect on readmissions at varying intervals.
Conclusion: A number of complications can arise from delayed management of hip fractures. The findings of our study suggest that emergency department medical teams as well as orthopedic teams should consider the pitfalls of delaying operative management of hip fractures.