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

Abstract

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 afterdischarge.METHODS: Deaths and readmissions were obtained by a linkage of databases of the HospitalInformation System of the Unified Health System and the System of Information on Mortalityof the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 orolder, with non-elective hospitalization for proximal femoral fracture was followed for 90 daysafter discharge. Cox multilevel model was used for discharge time until readmission, and thecharacteristics of the patients were used on the first level and the characteristics of the hospitalson 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 hospitalizedfor more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplastywhen 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 comparedwith 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 statisticallysignificant (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 patientsin the analysis of the data, also considering the correlation between readmission and mortalityto reduce biases