30-day and one-year readmission rate in 11,270 patients with surgical treatment for proximal femoral fractures across Austria

• Published in: Bone & joint open Vol. 5; no. 4; pp. 294 - 303
• Main Authors: Smolle, Maria A, Fischerauer, Stefan F, Vukic, Ines, Leitner, Lukas, Puchwein, Paul, Widhalm, Harald, Leithner, Andreas, Sadoghi, Patrick
• Format: Journal Article
• Language: English
• Published: England The British Editorial Society of Bone & Joint Surgery 11.04.2024
• Subjects: arthroplasties; chi-squared tests; comorbidities; complication; Composite Fixation; endoprosthesis; endoprosthetic replacement; femoral neck fractures; healthcare policy; hip hemiarthroplasties; Infected Gap Nonunion; Locking Plate; logistic regression models; Monorail Fixator; osteosyntheses; osteosynthesis; proximal femoral fracture; proximal femoral fractures; readmission; surgical treatment; Tibia; Trauma
• ISSN: 2633-1462; 2633-1462
• DOI: 10.1302/2633-1462.54.BJO-2024-0002.R1

Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated. The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications. Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population.