Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.

Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.

<h4>Objective</h4>In 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 sur...

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Autores principales: Caterina A Lund, Ann M Møller, Jørn Wetterslev, Lars H Lundstrøm
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2014
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Acceso en línea:https://doaj.org/article/7e8bc476a9994788825fa01fc33255eb
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spelling oai:doaj.org-article:7e8bc476a9994788825fa01fc33255eb2021-11-18T08:15:40ZOrganizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.1932-620310.1371/journal.pone.0099308https://doaj.org/article/7e8bc476a9994788825fa01fc33255eb2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24926876/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>In 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.<h4>Design</h4>Observational cohort study.<h4>Setting</h4>Prospectively 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.<h4>Participants</h4>6143 patients aged more than 65 years undergoing hip fracture surgery.<h4>Main outcome measures</h4>All-cause mortality.<h4>Results</h4>The 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, p<0.001) and 1.27 (1.06-1.51 CI, p<0.001), respectively. 'Priority of surgery' categorized as 'non-scheduled' is associated with mortality with a hazard ratio of 1.31 (1.13-1.50 CI, p<0.001). Surgical delay and time of surgery are not significantly associated with mortality.<h4>Conclusion</h4>Non-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.Caterina A LundAnn M MøllerJørn WetterslevLars H LundstrømPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 6, p e99308 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Caterina A Lund
Ann M Møller
Jørn Wetterslev
Lars H Lundstrøm
Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
description <h4>Objective</h4>In 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.<h4>Design</h4>Observational cohort study.<h4>Setting</h4>Prospectively 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.<h4>Participants</h4>6143 patients aged more than 65 years undergoing hip fracture surgery.<h4>Main outcome measures</h4>All-cause mortality.<h4>Results</h4>The 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, p<0.001) and 1.27 (1.06-1.51 CI, p<0.001), respectively. 'Priority of surgery' categorized as 'non-scheduled' is associated with mortality with a hazard ratio of 1.31 (1.13-1.50 CI, p<0.001). Surgical delay and time of surgery are not significantly associated with mortality.<h4>Conclusion</h4>Non-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.
format article
author Caterina A Lund
Ann M Møller
Jørn Wetterslev
Lars H Lundstrøm
author_facet Caterina A Lund
Ann M Møller
Jørn Wetterslev
Lars H Lundstrøm
author_sort Caterina A Lund
title Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
title_short Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
title_full Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
title_fullStr Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
title_full_unstemmed Organizational factors and long-term mortality after hip fracture surgery. A cohort study of 6143 consecutive patients undergoing hip fracture surgery.
title_sort organizational factors and long-term mortality after hip fracture surgery. a cohort study of 6143 consecutive patients undergoing hip fracture surgery.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/7e8bc476a9994788825fa01fc33255eb
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AT jørnwetterslev organizationalfactorsandlongtermmortalityafterhipfracturesurgeryacohortstudyof6143consecutivepatientsundergoinghipfracturesurgery
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