Smaller Hospitals, Higher Mortality Risk

The risk of death after hip fracture is higher for patients treated in small- and medium-sized hospitals than it is in teaching hospitals in Canada, according to a new study published in the CMAJ (Canadian Medical Association Journal).

There are 30, 000 hip fractures reported in Canada every year, and about 1 of 10 of these patients die in a hospital. In this study, researchers examined whether the location where patients underwent treatment for hip fractures may influence their chance of survival.

Canadian researchers looked at data on all patients aged 65 years or older who were hospitalized for a first hip fracture (168, 340) between January 2004 and December 2012.

Institutions that were members of the Association of Canadian Academic Healthcare Organizations were classified as teaching hospitals. All other hospitals were considered to be community hospitals and were grouped by their number of beds. Large hospitals had 200 or more beds; medium, 50 to 199 beds and small, less than 50 beds.

The researchers found that for every 1, 000 patients admitted to hospital with a hip fracture, 14 more die at medium community hospitals and 43 more at small community hospitals than those admitted to teaching hospitals. For every 1, 000 patients who undergo surgery to repair their hip fracture, 11 more die at medium community hospitals than at teaching hospitals.

“In the elderly, hip fractures occur as frequently as common cancers but with severely worse outcomes, ” states Dr. Katie Sheehan, School of Population and Public Health, University of British Columbia (UBC), Vancouver. “Even after treatment, 30% die within a year, 25% never walk again and 22% never live independently. These figures have not changed in the past 15 years, and qualify hip fractures as a major health care issue in Canada.”

Most patients undergo surgery to repair their hip fracture. The risk of death after surgery was higher at medium-sized community hospitals than it was at teaching hospitals. The higher risk may be a result of less timely care owing to fewer beds or staff or available equipment at medium community hospitals.

A small proportion of patients did not undergo surgery. These patients were also at higher risk of death when admitted to medium and small community hospitals than were those admitted to teaching hospitals. The study was conducted by the Canadian Collaborative Study of Hip Fractures.