Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

Abstract Background Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems. Methods We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death. Results The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries. Conclusion There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.

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A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

Anesthesiology ◽

10.1097/aln.0000000000002947 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1025-1035 ◽

Cited By ~ 2

Author(s):

Gavin M. Hamilton ◽

Manoj M. Lalu ◽

Reva Ramlogan ◽

Gregory L. Bryson ◽

Faraj W. Abdallah ◽

...

Keyword(s):

Hip Fracture ◽

Length Of Stay ◽

Resource Use ◽

Odds Ratio ◽

Instrumental Variable ◽

Adjusted Odds Ratio ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Hip Fracture Surgery ◽

Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). Methods The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. Results The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. Conclusions Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

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Comparison of general anaesthesia and regional anaesthesia in terms of mortality and complications in elderly patients with hip fracture: a nationwide population-based study

BMJ Open ◽

10.1136/bmjopen-2019-029245 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029245 ◽

Cited By ~ 8

Author(s):

Eun Jin Ahn ◽

Hyo Jin Kim ◽

Kyung Woo Kim ◽

Hey Ran Choi ◽

Hyun Kang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Insurance ◽

Hip Fracture ◽

Elderly Patients ◽

Regional Anaesthesia ◽

Secondary Outcome ◽

Hip Fracture Surgery ◽

Ventilator Care ◽

Fracture Surgery

ObjectiveTo evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery.SettingNationwide National Health Insurance Sharing Service database of Korea.ParticipantsAll patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015.InterventionsHip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture.Primary and secondary outcome measuresThe primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention.ResultsAmong the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI −0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI −0.0024 to 0.023, respectively).ConclusionRA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.

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Discharge to inpatient care facilities following hip fracture surgery: incidence, risk factors, and 30-day post-discharge outcomes

Hip International ◽

10.1177/1120700020920814 ◽

2020 ◽

pp. 112070002092081

Author(s):

Azeem Tariq Malik ◽

Nikhil Jain ◽

Travis L Frantz ◽

Carmen E Quatman ◽

Laura S Phieffer ◽

...

Keyword(s):

Hip Fracture ◽

Inpatient Care ◽

Care Facility ◽

Current Evidence ◽

Post Discharge ◽

Hip Fracture Surgery ◽

Discharge Outcomes ◽

Care Facilities ◽

Tract Infections ◽

Fracture Surgery

Background: Discharge to an inpatient care facility (skilled-care or rehabilitation) has been shown to be associated with adverse outcomes following elective total joint arthroplasties. Current evidence with regard to hip fracture surgeries remains limited. Methods: The 2015–2016 ACS-NSQIP database was used to query for patients undergoing total hip arthroplasty, hemiarthroplasty and open reduction internal fixation for hip fractures. A total of 15,655 patients undergoing hip fracture surgery were retrieved from the database. Inpatient facility discharge included discharges to skilled-care facilities and inpatient rehabilitation units. Multi-variate regression analysis was used to assess for differences in 30-day post-discharge outcomes between home-discharge versus inpatient care facility discharge, while adjusting for baseline differences between the 2 study populations. Results: A total of 12,568 (80.3%) patients were discharged to an inpatient care facility. Discharge to an inpatient care facility was associated with higher odds of any complication (OR 2.03 [95% CI, 1.61–2.55]; p < 0.001), wound complications (OR 1.79 [95% CI, 1.10–2.91]; p = 0.019), cardiac complications (OR 4.49 [95% CI, 1.40–14.40]; p = 0.012), respiratory complication (OR 2.29 [95% CI, 1.39–3.77]; p = 0.001), stroke (OR 7.67 [95% CI, 1.05–56.29]; p = 0.045, urinary tract infections (OR 2.30 [95% CI, 1.52–3.48]; p < 0.001), unplanned re-operations (OR 1.37 [95% CI, 1.03–1.82]; p = 0.029) and readmissions (OR 1.38 [95% CI, 1.16–1.63]; p < 0.001) following discharge. Conclusion: Discharge to inpatient care facilities versus home following hip fracture surgery is associated with higher odds of post-discharge complications, re-operations and readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimise the risk of complications.

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