MODERN surgical techniques are helping elderly patients to survive hip fractures. To see how postoperative care can influence survival, McGill University in Canada has carried out a retrospective cohort study.

Researchers examined the records over seven years of 12,457 people over the age of 65 years after a hemiarthroplasty. Most had been admitted from home with a hip fracture. There were 11,334 who survived and were discharged after surgery.

Most patients were discharged to another hospital or a nursing home. Almost 30% were sent home with no further care, 5.6% had additional care and 2% went to a rehabilitation centre.

Patients who received home care were more likely to have been treated in a teaching hospital. They had a lower risk of death than patients who were discharged without home care. Home care after hemiarthroplasty reduced the risk of death by 43%.

In the first three months after discharge, the rate of death per 100 patient-months was 1.5 with home care and 2.7 without it. Among the patients discharged to nursing homes, the rate was six per 100 patient-months.

COMMENT

The study’s findings imply that the wrong people are getting extra support at home. Those receiving home care tended to be younger and less likely to have arthritis.

Treatment should not end when the patient is discharged from hospital. The increase in mortality seen with shorter hospital stays could mean that patients are being discharged too soon. Nearly 3% of the patients were readmitted on the same day they were discharged.

Dr John Dowden, Canberra

Rahme E, Kahn SR, Dasgupta K, et al. Short-term mortality associated with failure to receive home care after hemiarthroplasty. CMAJ 2010; DOI: 10.1503/cmaj.091209