Readmission of older patients after hospital discharge for hip fracture: a multilevel approach.

OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08-1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06-1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41-0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09-2.68) and federal hospitals (HR = 1.81; 95%CI 1.00-3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.

Elderly readmission and death after discharge from treatment of hip fracture, occurred in public hospitals from 2008 to 2010, Rio de Janeiro.

OBJECTIVES: To estimate the risk of death and readmission of a cohort of elderly patients discharged after hip fracture treatment from hospitals of the public health system; to describe the causes of these events; and to compare the rates of readmission and death observed with those of the elderly population hospitalized in public hospitals of Rio de Janeiro city. METHODS: Data on deaths and readmissions were obtained through the linkage of these two data sources: the Hospital Information System of the Sistema Único de Saúde and the Mortality Information System from the city of Rio de Janeiro. The time frame for the study was 2008 to 2011. The population consisted of 2,612 individuals aged 60 years or older with nonelective hospitalization for hip fracture who were followed for a year after discharge. RESULTS: The readmission rate in one year, excluding the deaths in this period, was 17.8%, and the death rate was 18.6%. The most common causes of death were circulatory system diseases (29.5%). Approximately 15% of the causes of readmissions were surgical complications. The state hospitals showed lower readmission risks and higher death risks compared with the federal and municipal hospitals. It was observed that there is an excess risk of readmission and hospitalization of the study population compared with the elderly population hospitalized in the public hospitals of the city. CONCLUSION: Hospitalization of elderly individuals for hip fracture causes adverse outcomes such as readmissions and deaths. Many of these outcomes can be prevented from actions recommended in the National Policy for the Elderly Health.