Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

Autor: Jørn Wetterslev, Ann Merete Møller, Lars Hyldborg Lundstrøm, Caterina A. Lund
Rok vydání: 2014
Předmět:
Male
medicine.medical_specialty
Critical Care and Emergency Medicine
Science
Trauma Surgery
Orthopedic Surgery
Surgical and Invasive Medical Procedures
Time-to-Treatment
law.invention
Musculoskeletal System Procedures
Randomized controlled trial
Anesthesiology
Risk Factors
law
Outcome Assessment
Health Care
Medicine and Health Sciences
medicine
Humans
Anesthesia
Prospective Studies
Health Systems Strengthening
Prospective cohort study
Trauma Medicine
Aged
Aged
80 and over
Health Care Policy
Multidisciplinary
Hip Fractures
business.industry
Mortality rate
Hazard ratio
Health Risk Analysis
Length of Stay
Confidence interval
Surgery
Health Care
Geriatrics
Emergency medicine
Medicine
Female
Observational study
Health Services Research
Health Statistics
business
Body mass index
Research Article
Cohort study
Zdroj: PLoS ONE, Vol 9, Iss 6, p e99308 (2014)
PLoS ONE
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0099308
Popis: ObjectiveIn hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture surgery.DesignObservational cohort study.SettingProspectively and consecutively reported data from the Danish Anaesthesia Database were linked to The Danish National Registry of Patients and The Civil Registration System. Records on vital status, admittance, discharges, codes of diagnosis, anaesthetic and surgical procedures were retrieved.Participants6143 patients aged more than 65 years undergoing hip fracture surgery.Main outcome measuresAll-cause mortality.ResultsThe one year mortality was 30% (28-31%, 95% Confidence interval (CI)). In a multivariate model 'length of hospital stay' less than 10 days and more than 20 days are associated with mortality with hazard ratios of 1.34 (1.20-1.53 CI, pConclusionNon-scheduled surgery and length of hospital stay were associated with increased mortality. Confounding by indication may bias observational studies evaluating early and late discharge as well as priority; therefore cluster randomized clinical trials comparing different clinical set ups may be warranted evaluating health care organizational factors.
Databáze: OpenAIRE
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