Loss of pre-fracture basic mobility status at hospital discharge for hip fracture is associated with 30-day post-discharge risk of infections - A four-year nationwide cohort study of 23,309 Danish patients

Background: Limited information exists in neurosurgery regarding the association between functional status at hospital discharge and adverse events following discharge. Methods: A retrospective cohort study included all adults in one Boston teaching hospital who underwent neurosurgery between 2000-2012, survived hospitalization and had a Physical Therapist functional status assessment within 48-hours of discharge. 90-day post-discharge all-cause mortality was obtained from the US Social Security Administration Death Master File. Logistic regression analysis was used. Results: 2,369 patients were included, comprising 65% cranial and 35% spinal. Malignancy and trauma was 47% and 13%, respectively. 238 patients had independent functional status. 90-day mortality and readmission was 8.3% and 28%, respectively. Second, third and lowest quartile of functional status was associated with a 3.16 (95%CI 1.08-9.24), 6.00 (2.11-17.04) and 6.26 (2.16-18.16) respective increased odds of 90-day post-discharge mortality compared to patients with independent functional status, adjusting for age, gender, race, length of stay, presence of malignancy and Deyo-Charlson comorbidity. Good discrimination (AUC 0.82) and calibration (Hosmer-Lemeshow χ2 P = 0.23) were demonstrated. Adjusted odds of 90-day readmission in patients with the lowest quartile of functional status was 1.89 (1.28-2.80) higher than patients with independent functional status. Conclusions: Lower functional status at hospital discharge following neurosurgery is associated with increased post-discharge mortality and hospital readmission.

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The basic mobility status upon acute hospital discharge is an independent risk factor for mortality up to 5 years after hip fracture surgery

Acta Orthopaedica ◽

10.1080/17453674.2017.1382038 ◽

2017 ◽

Vol 89 (1) ◽

pp. 47-52 ◽

Cited By ~ 15

Author(s):

Morten T Kristensen ◽

Henrik Kehlet

Keyword(s):

Risk Factor ◽

Hip Fracture ◽

Hospital Discharge ◽

Independent Risk Factor ◽

Acute Hospital ◽

Hip Fracture Surgery ◽

Fracture Surgery ◽

Mobility Status

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Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003804 ◽

2021 ◽

Vol 18 (9) ◽

pp. e1003804

Author(s):

Shoshana J. Herzig ◽

Timothy S. Anderson ◽

Yoojin Jung ◽

Long Ngo ◽

Dae H. Kim ◽

...

Keyword(s):

Older Adults ◽

Renal Failure ◽

Acute Renal Failure ◽

Cohort Study ◽

Adverse Events ◽

Hospital Discharge ◽

Healthcare Utilization ◽

Colonic Motility ◽

Post Discharge ◽

Propensity Matching

Background Although analgesics are initiated on hospital discharge in millions of adults each year, studies quantifying the risks of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) among older adults during this transition are limited. We sought to determine the incidence and risk of post-discharge adverse events among older adults with an opioid claim in the week after hospital discharge, compared to those with NSAID claims only. Methods and findings We performed a retrospective cohort study using a national sample of Medicare beneficiaries age 65 and older, hospitalized in the United States hospitals in 2016. We excluded beneficiaries admitted from or discharged to a facility. We derived a propensity score that included over 100 factors potentially related to the choice of analgesic, including demographics, diagnoses, surgeries, and medication coadministrations. Using 3:1 propensity matching, beneficiaries with an opioid claim in the week after hospital discharge (with or without NSAID claims) were matched to beneficiaries with an NSAID claim only. Primary outcomes included death, healthcare utilization (emergency department [ED] visits and rehospitalization), and a composite of known adverse effects of opioids or NSAIDs (fall/fracture, delirium, nausea/vomiting, complications of slowed colonic motility, acute renal failure, and gastritis/duodenitis) within 30 days of discharge. After 3:1 propensity matching, there were 13,385 beneficiaries in the opioid cohort and 4,677 in the NSAID cohort (mean age: 74 years, 57% female). Beneficiaries receiving opioids had a higher incidence of death (1.8% versus 1.1%; RR 1.7 [1.3 to 2.3], p < 0.001, number needed to harm [NNH] 125), healthcare utilization (19.0% versus 17.4%; RR 1.1 [1.02 to 1.2], p = 0.02, NNH 59), and any potential adverse effect (25.2% versus 21.3%; RR 1.2 [1.1 to 1.3], p < 0.001, NNH 26), compared to those with an NSAID claim only. Specifically, they had higher relative risk of fall/fracture (4.5% versus 3.4%; RR 1.3 [1.1 to 1.6], p = 0.002), nausea/vomiting (9.2% versus 7.3%; RR 1.3 [1.1 to 1.4], p < 0.001), and slowed colonic motility (8.0% versus 6.2%; RR 1.3 [1.1 to 1.4], p < 0.001). Risks of delirium, acute renal failure, and gastritis/duodenitis did not differ between groups. The main limitation of our study is the observational nature of the data and possibility of residual confounding. Conclusions Older adults filling an opioid prescription in the week after hospital discharge were at higher risk for mortality and other post-discharge adverse outcomes compared to those filling an NSAID prescription only.

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Fall-risk increasing drugs and recurrent injurious falls association in older patients after hip fracture: a cohort study protocol

Therapeutic Advances in Drug Safety ◽

10.1177/2042098619868640 ◽

2019 ◽

Vol 10 ◽

pp. 204209861986864 ◽

Cited By ~ 2

Author(s):

Andrea Correa-Pérez ◽

Eva Delgado-Silveira ◽

Sagrario Martín-Aragón ◽

Alfonso J. Cruz-Jentoft

Keyword(s):

Cohort Study ◽

Hip Fracture ◽

Hospital Discharge ◽

Fall Risk ◽

Hospital Admissions ◽

Emergency Department Visits ◽

High Risk Population ◽

Very Old ◽

Injurious Falls

Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. However, no information is available about the association between FRIDS and injurious falls after hospital discharge due to hip fracture in a very old population. We aim to assess the association between the use of FRIDS at discharge and injurious falls in patients older than 80 years hospitalized due to a hip fracture. A retrospective cohort study using routinely collected health data will be conducted at the Orthogeriatric Unit of a teaching hospital. Patients will be included at hospital discharge (2014), with a 2-year follow-up. Fall-risk increasing drugs will be recorded at hospital discharge, and exposure to drugs will be estimated from usage records during the 2-year follow-up. Injurious falls are defined as falls that lead to any kind of health care (primary or specialized care, including emergency department visits and hospital admissions). A sample size of 193 participants was calculated, assuming that 40% of patients who receive any FRID at discharge, and 20% who do not, will experience an injurious fall during follow up. This protocol explains the study methods and the planned analysis. We expect to find a relevant association between FRIDS at hospital discharge and the incidence of injurious falls in this very old, high risk population. If confirmed, this would support the need for a careful pharmacotherapeutic review in patients discharged after a hip fracture. However, results should be carefully interpreted due to the risk of bias inherent to the study design.

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Regaining pre-fracture basic mobility status after hip fracture and association with post-discharge mortality and readmission—a nationwide register study in Denmark

Age and Ageing ◽

10.1093/ageing/afy185 ◽

2019 ◽

Vol 48 (2) ◽

pp. 278-284 ◽

Cited By ~ 5

Author(s):

Morten Tange Kristensen ◽

Buket Öztürk ◽

Niels Dieter Röck ◽

Annette Ingeman ◽

Henrik Palm ◽

...

Keyword(s):

Hip Fracture ◽

Register Study ◽

Post Discharge ◽

Nationwide Register Study ◽

Mobility Status

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Achieved blood pressure post-acute kidney injury and risk of adverse outcomes after AKI: A prospective parallel cohort study

BMC Nephrology ◽

10.1186/s12882-021-02480-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ian McCoy ◽

Sandeep Brar ◽

Kathleen D. Liu ◽

Alan S. Go ◽

Raymond K. Hsu ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Cohort Study ◽

Hospital Discharge ◽

Kidney Function ◽

Kidney Injury ◽

Adverse Outcomes ◽

Post Discharge ◽

Full Cohort ◽

Interaction Testing

Abstract Background There has recently been considerable interest in better understanding how blood pressure should be managed after an episode of hospitalized AKI, but there are scant data regarding the associations between blood pressure measured after AKI and subsequent adverse outcomes. We hypothesized that among AKI survivors, higher blood pressure measured three months after hospital discharge would be associated with worse outcomes. We also hypothesized these associations between blood pressure and outcomes would be similar among those who survived non-AKI hospitalizations. Methods We quantified how systolic blood pressure (SBP) observed three months after hospital discharge was associated with risks of subsequent hospitalized AKI, loss of kidney function, mortality, and heart failure events among 769 patients in the prospective ASSESS-AKI cohort study who had hospitalized AKI. We repeated this analysis among the 769 matched non-AKI ASSESS-AKI enrollees. We then formally tested for AKI interaction in the full cohort of 1538 patients to determine if these associations differed among those who did and did not experience AKI during the index hospitalization. Results Among 769 patients with AKI, 42 % had subsequent AKI, 13 % had loss of kidney function, 27 % died, and 18 % had heart failure events. SBP 3 months post-hospitalization did not have a stepwise association with the risk of subsequent AKI, loss of kidney function, mortality, or heart failure events. Among the 769 without AKI, there was also no stepwise association with these risks. In formal interaction testing using the full cohort of 1538 patients, hospitalized AKI did not modify the association between post-discharge SBP and subsequent risks of adverse clinical outcomes. Conclusions Contrary to our first hypothesis, we did not observe that higher stepwise blood pressure measured three months after hospital discharge with AKI was associated with worse outcomes. Our data were consistent with our second hypothesis that the association between blood pressure measured three months after hospital discharge and outcomes among AKI survivors is similar to that observed among those who survived non-AKI hospitalizations.

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