McPhail SM1,2, Mathew S1,2, Jun D1,2, Heesch K1
1Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia, 2Metro South Hospital and Health Service, Centre for Functioning and Health Research, Brisbane, Australia
Background: Age-related frailty and fractures can cause substantial negative impacts for older adults, their family and carers, as well as society more broadly who fund healthcare and age-care services. A recent systematic review highlighted that almost all studies in the field have focused specifically on patients with hip fractures, which is likely due to both their high prevalence rate and potential for severe impact. However, understanding more about risk of hospital readmission and mortality after other common fracture types that affect older adults will likely assist physiotherapists and the multidisciplinary team more broadly to develop targeted intervention strategies for those at greatest risk.
Purpose: The purpose of this study was to investigate rates of emergency re-presentations to hospital and mortality within 30 days post-index-hospitalisation for an osteoporosis-related fracture among older adults. The study also examined factors associated with risk of emergency re-presentation and mortality (within 30 days post-hospitalisation).
Methods: A data-linkage study was conducted in the state of Queensland, Australia. Adults aged ≥ 65 years who were hospitalised for a fragility fracture were identified using ICD-10 codes and were eligible for inclusion. Linked emergency department records and government death records were used to identify re-presentations within 30 days to public or private emergency departments and mortality within 30 days. Time-to-event (survival) models were used to investigate patient and clinical factors associated with hospital re-presentation and mortality rates.
Results: Overall, n=9792 unique patients from 53 hospitals were included (n=6889 (70.5%) female, mean (SD) age 80 (8.6) years). The most common skeletal fracture-sites were hip (n=4997, 50.8%), pelvis (n=1218, 12.4%), humerus (n=713, 7.3%) wrist and hand (n=674, 6.9%), and rib (n=671, 6.9%). Within 30 days, n=1278 of these patients had re-presented to an emergency department. A wide-range of factors were associated with elevated re-presentation rates including wrist (HR= 1.49; 95%CI 1.20, 1.84), or humerus (HR= 1.38; 95%CI 1.09, 1.74) fractures (versus hip); male sex (HR= 1.14; 95%CI: 1.07, 1.22), older age (HR=1.09 per decade; 95%CI 1.01, 1.18), living in an outer (HR= 1.23; 95%CI 1.04, 1.45) or very remote (HR= 1.70; 95%CI 1.00, 2.90) region versus metropolitan cities, among other factors. Factors associated with an elevated post-discharge mortality rate included male sex (HR: 1.43; 95%CI: 1.26, 1.62), older age (HR: 1.99 per decade; 95%CI: 1.67, 2.36), and presenting from residential aged care (HR= 5.33; 95%CI 3.93, 7.21), among other factors. Patients with pelvis (HR= 0.56; 95%CI 0.34, 0.91), humerus (HR= 0.51; 95%CI 0.26, 1.00), or wrist fractures (HR= 0.44; 95%CI 0.20, 0.96) had a lower risk of 30 day mortality (than hip).
Conclusion(s): This study was novel in reporting findings for a range of fracture types and inclusion of emergency presentations both with and without inpatient admissions. A broad range of patient-related, clinical, and environmental factors were associated with re-presentations and mortality.
Implications: These findings may be useful for clinical teams seeking to understand and reduce undesirable outcomes among older adults hospitalised with fractures or those seeking to inform health service planning for post-hospitalisation or transition care services for older adults who have been hospitalised with fractures.
Keywords: Fracture, Osteoprosis, Frailty
Funding acknowledgements: SMM is supported by funding from the National Health and Medical Research Council (of Australia) and Medical Research Future Fund.
Purpose: The purpose of this study was to investigate rates of emergency re-presentations to hospital and mortality within 30 days post-index-hospitalisation for an osteoporosis-related fracture among older adults. The study also examined factors associated with risk of emergency re-presentation and mortality (within 30 days post-hospitalisation).
Methods: A data-linkage study was conducted in the state of Queensland, Australia. Adults aged ≥ 65 years who were hospitalised for a fragility fracture were identified using ICD-10 codes and were eligible for inclusion. Linked emergency department records and government death records were used to identify re-presentations within 30 days to public or private emergency departments and mortality within 30 days. Time-to-event (survival) models were used to investigate patient and clinical factors associated with hospital re-presentation and mortality rates.
Results: Overall, n=9792 unique patients from 53 hospitals were included (n=6889 (70.5%) female, mean (SD) age 80 (8.6) years). The most common skeletal fracture-sites were hip (n=4997, 50.8%), pelvis (n=1218, 12.4%), humerus (n=713, 7.3%) wrist and hand (n=674, 6.9%), and rib (n=671, 6.9%). Within 30 days, n=1278 of these patients had re-presented to an emergency department. A wide-range of factors were associated with elevated re-presentation rates including wrist (HR= 1.49; 95%CI 1.20, 1.84), or humerus (HR= 1.38; 95%CI 1.09, 1.74) fractures (versus hip); male sex (HR= 1.14; 95%CI: 1.07, 1.22), older age (HR=1.09 per decade; 95%CI 1.01, 1.18), living in an outer (HR= 1.23; 95%CI 1.04, 1.45) or very remote (HR= 1.70; 95%CI 1.00, 2.90) region versus metropolitan cities, among other factors. Factors associated with an elevated post-discharge mortality rate included male sex (HR: 1.43; 95%CI: 1.26, 1.62), older age (HR: 1.99 per decade; 95%CI: 1.67, 2.36), and presenting from residential aged care (HR= 5.33; 95%CI 3.93, 7.21), among other factors. Patients with pelvis (HR= 0.56; 95%CI 0.34, 0.91), humerus (HR= 0.51; 95%CI 0.26, 1.00), or wrist fractures (HR= 0.44; 95%CI 0.20, 0.96) had a lower risk of 30 day mortality (than hip).
Conclusion(s): This study was novel in reporting findings for a range of fracture types and inclusion of emergency presentations both with and without inpatient admissions. A broad range of patient-related, clinical, and environmental factors were associated with re-presentations and mortality.
Implications: These findings may be useful for clinical teams seeking to understand and reduce undesirable outcomes among older adults hospitalised with fractures or those seeking to inform health service planning for post-hospitalisation or transition care services for older adults who have been hospitalised with fractures.
Keywords: Fracture, Osteoprosis, Frailty
Funding acknowledgements: SMM is supported by funding from the National Health and Medical Research Council (of Australia) and Medical Research Future Fund.
Topic: Older people; Orthopaedics; Musculoskeletal
Ethics approval required: Yes
Institution: Metro South Health
Ethics committee: Metro South Health Human Research Ethics Committee
Ethics number: HREC/15/QPAH/317
All authors, affiliations and abstracts have been published as submitted.
