Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis
Tóm tắt
Older adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures. Four electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age ≥ 65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible. Eleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores > 3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation ≤ 30 days (pooled OR, 1.27; 95 % CI, 1.14–1.43) and > 30 days (pooled OR, 1.23; 95 % CI, 1.01–1.50). The best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature. PROSPERO
CRD42015019379
.
Tài liệu tham khảo
Aoyagi K. Osteoporosis and osteoporotic fractures in the elderly. Acta Med Nagasaki. 2004;49(1–2):7–11.
Burke-Doe A, Hudson A, Werth H, Riordan DG. Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls and fracture in functionally independent older adults. J Geriatr Phys Ther. 2008;31(1):11–7.
Flores P. Osteoporosis. Health Central. http://www.healthcentral.com/osteoporosis/c/76444/76340/fragility/. Accessed 24 Mar 2016.
Gerdhem P. Osteoporosis and fragility fractures: vertebral fractures. Best Pract Res Clin Rheumatol. 2013;27(6):743–55.
Roland M, Dusheiko M, Gravelle H, Parker S. Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data. BMJ. 2005;330(7486):289–92.
McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. J Risk Manag Healthc Policy. 2016;9:143–56.
Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer M, Dodel R, Ruchholtz S. Re-admission to level 2 unit after hip-fracture surgery – risk factors, reasons and outcome. Injury. 2013;44(12):1919–25.
Hahnel J, Burdekin H, Anand S. Re-admissions following hip fracture surgery. Ann R Coll Surg Engl. 2009;91(7):591–5.
Moore G, Gerdtz M, Manias E, Hepworth G, Dent A. Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery. BMC Public Health. 2007;7:1.
Minnee D, Wilkinson J. Return visits to the emergency department and related hospital admissions by people aged 65 and over. N Z Med J. 2011;124(1331):67–74.
Khan SK, Kalra S, Khanna A, Thiruvengada MM, Parker MJ. Timing of surgery for hip fractures: a systematic review of 52 published studies involving 291,413 patients. Injury. 2009;40(7):692–7.
Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN. A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag. 2014;10:937–48.
García-Pérez L, Linertová R, Lorenzo-Riera A, Vázquez-Díaz JR, Duque-González B, Sarría-Santamera A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM. 2011;104(8):639–51.
Mathew S, Heesch K, Gane E, McPhail S. Risk factors for hospital re-presentation among older adults following fragility fractures: protocol for a systematic review. Syst Rev. 2015;4:91.
Deeks JJ, Dinnes J, D’amico R, Sowden A, Sakarovitch C, Song F, Petticrew M, Altman D. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7(27):1–179.
Jackson N, Waters E. Criteria for the systematic review of health promotion and public health interventions. Health Promot Int. 2005;20(4):367–74.
Slavin RE. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol. 1995;48(1):9–18.
Borenstein M, Hedges LV, Higgins J, Rothstein HR. Front matter. Introduction to Meta-Analysis. Chichester: John Wiley & Sons, Ltd.; 2009. doi: 10.1002/9780470743386.fmatter.
Ling XW, Howe TS, Koh JSB, Wong MK, Ng ACM. Preoperative thyroid dysfunction predicts 30-day postoperative complications in elderly patients with hip fracture. Geriatr Orthop Surg Rehabil. 2013;4(2):43–9.
Bischoff-Ferrari HA, Dawson-Hughes B, Platz A, Orav EJ, Stahelin HB, Willett WC, Can U, Egli A, Mueller NJ, Looser S, et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med. 2010;170(9):813–20.
Boddaert J, Cohen-Bittan J, Khiami F, Le Manach Y, Raux M, Beinis JY, Verny M, Riou B. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS One. 2014;9(1):e83795.
Vochteloo AJ, van der Burg BL B, Mertens B, Niggebrugge AH, de Vries MR, Tuinebreijer WE, Bloem RM, Nelissen RG, Pilot P. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. BMC Musculoskelet Disord. 2011;12:262.
Hsiao F-Y, Huang W-F, Chen Y-M, Wen Y-W, Kao Y-H, Chen L-K, Tsai Y-W. Hip and subtrochanteric or diaphyseal femoral fractures in alendronate users: a 10-year, nationwide retrospective cohort study in Taiwanese women. Clin Ther. 2011;33(11):1659–67.
Jou HJ, Siao RY, Tsai YS, Chen YT, Li CY, Chen CC. Postdischarge rehospitalization and in-hospital mortality among Taiwanese women with hip fracture. Taiwan J Obstet Gynecol. 2014;53(1):43–7.
French DD, Bass E, Bradham DD, Campbell RR, Rubenstein LZ. Rehospitalization after hip fracture: predictors and prognosis from a national veterans study. J Am Geriatr Soc. 2008;56(4):705–10.
Heidari N, Jehan S, Alazzawi S, Bynoth S, Bottle A, Loeffler M. Mortality and morbidity following hip fractures related to hospital thromboprophylaxis policy. Hip Int. 2012;22(1):13–21.
Halm EA, Magaziner J, Hannan EL, Wang JJ, Silberzweig SB, Boockvar K, Orosz GM, McLaughlin MA, Koval KJ, Siu AL. Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture. Arch Intern Med. 2003;163(1):108–13.
Kates SL, Behrend C, Mendelson DA, Cram P, Friedman SM. Hospital readmission after hip fracture. Arch Orthop Trauma Surg. 2014;135(3):329–37.
Heyes GJ, Tucker A, Marley D, Foster A. Predictors for readmission up to 1 year following hip fracture. Arch Trauma Res. 2015;4(2):e27123.
Basques BA, Bohl DD, Golinvaux NS, Leslie MP, Baumgaertner MR, Grauer JN. Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients. J Orthop Trauma. 2015;29(3):e115–20.
Fox KM, Hawkes WG, Hebel JR, Felsenthal G, Clark M, Zimmerman SI, Kenzora JE, Magaziner J. Mobility after hip fracture predicts health outcomes. J Am Geriatr Soc. 1998;46(2):169–73.
Giusti A, Barone A, Razzano M, Pizzonia M, Oliveri M, Pioli G. Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: one-year follow-up. Aging Clin Exp Res. 2008;20(3):253–9.
Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, Koval KJ, Siu AL. Effects of blood transfusion on clinical and functional outcomes in patients with hip fracture. Transfusion. 2003;43(10):1358–65.
Halm EA, Wang JJ, Boockvar K, Penrod J, Silberzweig SB, Magaziner J, Koval KJ, Siu AL. The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture. J Orthop Trauma. 2004;18(6):369–74.
Härstedt M, Rogmark C, Sutton R, Melander O, Fedorowski A. Impact of comorbidity on 6-month hospital readmission and mortality after hip fracture surgery. Injury. 2015;46(4):713–8.
Khan MA, Hossain FS, Dashti Z, Muthukumar N. Causes and predictors of early re-admission after surgery for a fracture of the hip. J Bone Joint Surg. 2012;94(5):690–7.
Le-Wendling L, Bihorac A, Baslanti TO, Lucas S, Sadasivan K, Wendling A, Heyman HJ, Boezaart A. Regional anesthesia as compared with general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality, and health care costs? Results of a single-centered study. Pain Med. 2012;13(7):948–56.
Merchant RA, Lui KL, Ismail NH, Wong HP, Sitoh YY. The relationship between postoperative complications and outcomes after hip fracture surgery. Ann Acad Med Singapore. 2005;34(2):163–8.
Riggs RV, Roberts PS, Aronow H, Younan T. Joint replacement and hip fracture readmission rates: impact of discharge destination. PM R. 2010;2(9):806–10.
Teixeira A, Trinquart L, Raphael M, Bastianic T, Chatellier G, Holstein J. Outcomes in older patients after surgical treatment for hip fracture: a new approach to characterise the link between readmissions and the surgical stay. Age Ageing. 2009;38(5):584–9.
Toy JO, Basques BA, Grauer JN. Morbidity, mortality, and readmission after vertebral augmentation: analysis of 850 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Spine. 2014;39(23):1943–9.
Gregersen M, Zintchouk D, Borris LC, Damsgaard EM. A geriatric multidisciplinary and tailor-made hospital-at-home method in nursing home residents with hip fracture. Geriatr Orthop Surg Rehabil. 2011;2(4):148–54.
Hageman MGJS, Bossen JKJ, Smith RM, Ring D. Predictors of readmission in orthopaedic trauma surgery. J Orthop Trauma. 2014;28(10):e247–9.
Intrator O, Berg K. Benefits of home health care after inpatient rehabilitation for hip fracture: health service use by Medicare beneficiaries, 1987–1992. Arch Phys Med Rehabil. 1998;79(10):1195–9.
Kiel DP, Eichorn A, Intrator O, Silliman RA, Mor V. The outcomes of patients newly admitted to nursing homes after hip fracture. Am J Public Health. 1994;84(8):1281–6.
Ottenbacher KJ, Smith PM, Illig SB, Peek MK, Fiedler RC, Granger CV. Hospital readmission of persons with hip fracture following medical rehabilitation. Arch Gerontol Geriatr. 2003;36(1):15–22.
Tsai YW, Hsiao FY, Wen YW, Kao YH, Chang LC, Huang WF, Peng LN, Liu CL, Chen LK. Clinical outcomes of vertebroplasty or kyphoplasty for patients with vertebral compression fractures: a nationwide cohort study. J Am Med Dir Assoc. 2013;14(1):41–7.
Golinvaux NS, Bohl DD, Basques BA, Baumgaertner MR, Grauer JN. Diabetes confers little to no increased risk of postoperative complications after hip fracture surgery in geriatric patients. Clin Orthop Relat Res. 2014;473(3):1043–51.
Kates SL, Shields E, Behrend C, Noyes KK. Financial implications of hospital readmission after hip fracture. Geriatr Orthop Surg Rehabil. 2015;6(3):140–6.
Pollock FH, Bethea A, Samanta D, Modak A, Maurer JP, Chumbe JT. Readmission within 30 days of discharge after hip fracture care. Orthopedics. 2015;38(1):e7–13.
Radcliff TA, Henderson WG, Stoner TJ, Khuri SF, Dohm M, Hutt E. Patient risk factors, operative care, and outcomes among older community-dwelling male veterans with hip fracture. J Bone Joint Surg Am. 2008;90A(1):34–42.
Zhang AL, Schairer WW, Feeley BT. Hospital readmissions after surgical treatment of proximal humerus fractures: is arthroplasty safer than open reduction internal fixation? Clin Orthop Relat Res. 2014;472(8):2317–24.
Toson B, Harvey LA, Close JC. The ICD-10 Charlson Comorbidity Index predicted mortality but not resource utilization following hip fracture. J Clin Epidemiol. 2015;68(1):44–51.
Courtney M, Edwards H, Chang A, Parker A, Finlayson K, Hamilton K. Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24‐week exercise and telephone follow‐up program. J Am Geriatr Soc. 2009;57(3):395–402.
Graves N, Courtney M, Edwards H, Chang A, Parker A, Finlayson K. Cost-effectiveness of an intervention to reduce emergency re-admissions to hospital among older patients. PLoS One. 2009;4(10):e7455.
Dailey EA, Cizik A, Kasten J, Chapman JR, Lee MJ. Risk factors for readmission of orthopaedic surgical patients. J Bone Joint Surg Am. 2013;95(11):1012–9.
Garcia-Aymerich J, Farrero E, Felez M, Izquierdo J, Marrades R, Anto J. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003;58(2):100–5.
Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39(3):238–47.
Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Reduction of 30‐day postdischarge hospital readmission or emergency department (ED) visit rates in high‐risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211–8.