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Deutscher Kongress für Orthopädie und Unfallchirurgie
74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie
51. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

26. - 29.10.2010, Berlin

Transfer patients have worse observed and expected outcomes compared to non-transfer patients after treatment for hip fracture at a regional referral center

Meeting Abstract

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  • J. Wiggers - MGH, Boston, United States
  • T. G. Guitton - MGH, Boston, United States
  • D. Ring - MGH, Boston, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie. 74. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 96. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 51. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 26.-29.10.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocIN24-1674

DOI: 10.3205/10dkou153, URN: urn:nbn:de:0183-10dkou1532

Published: October 21, 2010

© 2010 Wiggers et al.
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Outline

Text

Objective: Hospitals and providers that accept transfer patients risk lower ratings on publically reported quality measures that are inadequately adjusted for infirmity and complexity. We compared the outcomes of patients aged 65 and older transferred to a tertiary care referral center for treatment of a hip fracture to the outcomes of non-transfer patients and tested the null hypothesis that transfer patients have expected lengths of stay based on APR-DRG (All Patient Refined-Diagnosis Related Groups) norms and actual observed lengths of stay comparable to non-transfer patients.

Methods: One hundred twenty-three consecutive patients that were transferred from another acute care facility or a skill nursing facility were retrospectively compared to 283 consecutive non-transfer patients with respect to in-hospital mortality, length of stay (LOS), excess days over the Geometric Mean Length of Stay, and readmission rate as well as Expected Length Of Stay (Exp LOS) and Expected Mortality (Exp Mort), based on APR-DRG norms.

Results and conclusions: Transfer patients had significantly greater LOS (10.2 vs. 9.6 days; p<0.05), Exp LOS (9.7 vs. 7.7 days; p<0.001), Exp Mort (0.07 vs. 0.03; p=0.004), and excess days over the GMLOS (4.1 vs. 3.3 days; p=0.025) than non-transfer patients, near-significant greater in-hospital mortality (9.8% vs. 4.9%; p=0.069), and comparable readmission rates. The differences in LOS and Exp LOS were non-significant in both transfer (p = 0.49) and non-transfer patients (p=0.10).

Patients aged 65 and older transferred to a tertiary care facility for treatment of an acute hip fracture are sicker than non-transfer patients. Unadjusted data such as in-hospital mortality may be misleading, but risk adjustment using the APR-DRG methodology may provide meaningful benchmarks.