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Hip fracture

A prospective study of hospital course, complications, and costs

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Abstract

A prospective study of 79 patients with recent hip fracture revealed prior functional impairments with community mobility (49%), using a bathtub (40%), walking outdoors (26%), and stair-climbing (18%). Eighty-six per cent of patients (mean age 77.9 years) were admitted from home, with 95% surviving to discharge but only 28% returning directly home following surgical repair. In-hospital complications included confusion (49%), urinary tract infection (33%), and heart rhythm disturbance (26%). Mean length of stay was 21.7 days and mean hospital charges were $11,052. The outliers (15%) averaged 60.6 days in length of stay and $28,190 in charges. Stepwise multivariate regression revealed that lengths of stay varied significantly with prefracture functional status, presence of intertrochanteric fractures, and in-hospital complications, but not with patient age. Examination of these findings in relation to prospective reimbursement led to the conclusion that hip fracture patients are particularly vulnerable in the era of new hospital strategies to avoid high-cost patients and curtail hospital costs.

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References

  1. Boyce WJ, Vessey MP. Rising incidence of fracture of the proximal femur. Lancet 1985; 1: 150–1

    Article  PubMed  CAS  Google Scholar 

  2. Hielema FJ. Epidemiology of hip fracture. Physical Therapy 1979; 59:1221–5

    PubMed  CAS  Google Scholar 

  3. Owen RA, Melton LJ, Gallagher JC, et al. The national cost of the acute care of hip fractures associated with osteoporosis. Clin Orthop 1980; 150:172–6

    PubMed  Google Scholar 

  4. Anonymous. The physician’s DRG working guidebook. St. Anthony’s Hospital, Louisville, KY, 1984

  5. Nickens HW. A review of factors affecting occurrence and outcome of hip fracture with special reference to psychosocial issues. J Am Geriatr Soc 1983; 31:166–70

    PubMed  CAS  Google Scholar 

  6. Miller CW. Survival and ambulation following hip fracture. J Bone Joint Surg 1978; 60A:930–3

    Google Scholar 

  7. Jensen JS, Bagger J. Long-term social prognosis after hip fractures. Acta Orthop Scand 1982; 53:97–101

    Article  PubMed  CAS  Google Scholar 

  8. Keene JS, Anderson CA. Hip fractures in the elderly. JAMA 1982; 248:564–7

    Article  PubMed  CAS  Google Scholar 

  9. Jette AM. The functional status index: reliability of a chronic disease evaluation instrument. Arch Phys Med Rehab 1980; 61:395–401

    CAS  Google Scholar 

  10. Harris BA, Jette AM, Campion EW, Cleary PD. Validity of self-report measures of functional disability. Topics in Geriatric Rehabilitation 1986; 1:3

    Google Scholar 

  11. Brook R, Ware J, Davies-Avery A, et al. Conceptualization and measurement of health for adults in a health insurance study. Volume VIII. Santa Monica: Rand Corporation, 1979

    Google Scholar 

  12. Veit CT, Ware JE. The structure of psychological distress and well-being in general populations. J Consult Clin Psychol 1983; 51:730–42

    Article  PubMed  CAS  Google Scholar 

  13. Evarts CM. Femoral neck classification. In: Evarts CM, ed. Surgery of the musculoskeletal system. New York: Churchill Livingstone, 1983; 6:76

    Google Scholar 

  14. Schroeder SA, Showstack JA, Roberts HE. Frequency and clinical description of high-cost patients in 17 acute-care hospitals. N Engl J Med 1979; 300:1306–9

    Article  PubMed  CAS  Google Scholar 

  15. Zook CJ, Moore FD. High-cost users of medical care. N Engl J Med 1980; 302:996–1002

    Article  PubMed  CAS  Google Scholar 

  16. Brody SJ, Mangel JS. DRG: the second revolution in health care for the elderly. J Am Geriatr Soc 1984; 32:676–9

    PubMed  CAS  Google Scholar 

  17. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB. Hip fracture mortality. Clin Orthop Rel Res 1984; 186:45–55

    Google Scholar 

  18. Campion EW, Mulley AG, Goldstein RL, Barnett GO, Thibault GE. Medical intensive care for the elderly. JAMA 1981; 246:2052–6

    Article  PubMed  CAS  Google Scholar 

  19. Crane JG, Kernek CB. Mortality associated with hip fractures in a single geriatric hospital and residential facility. J Am Geriatr Soc 1983; 31:472–5

    PubMed  CAS  Google Scholar 

  20. Niemann KMW, Mankin HJ. Fractures about the hip in an institutionalized population. J Bone Joint Surg 1968; 50A:1327–40

    Google Scholar 

  21. Jette AM, Branch LG. The Framingham disability study: physical disability among the aging. Am J Pub Health 1981; 71:1211–6

    Article  PubMed  CAS  Google Scholar 

  22. Evans JG, Prudham D, Wandless I. A prospective study of fractured proximal femur: factors predisposing to survival. Age Ageing 1979; 8:246–50

    Article  PubMed  CAS  Google Scholar 

  23. Consensus conference. Osteoporosis. JAMA 1984; 252:799–802

    Google Scholar 

  24. Riggs BL, Melton LJ. Involutional osteoporosis. N Engl J Med 1986; 26:1676–84

    Article  Google Scholar 

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Author notes

  1. Edward W. Campion MD

    Present address: Geriatrics Unit, Massachusetts General Hospital and Spaulding Rehabilitation Hospital, Division on Aging, Harvard Medical School, Boston, Massachusetts

Authors and Affiliations

  1. Massachusetts General Hospital, Boston, Massachusetts

    Alan M. Jette PT, MPH, PhD (Institute of Health Professions) & Bette Ann Harris MS, PT

  2. Department of Social Medicine and Health Policy, Harvard Medical School, Boston, Massachusetts

    Paul D. Cleary PhD

Authors
  1. Edward W. Campion MD
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  2. Alan M. Jette PT, MPH, PhD
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  3. Paul D. Cleary PhD
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  4. Bette Ann Harris MS, PT
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Supported by a grant from The Robert Wood Johnson Foundation.

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Campion, E.W., Jette, A.M., Cleary, P.D. et al. Hip fracture. J Gen Intern Med 2, 78–82 (1987). https://doi.org/10.1007/BF02596300

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