The Impact of Hospital Volume and Region on Mortality, Medical Costs, and Length of Hospital Stay in Elderly Patients Following Hip Fracture: A Nationwide Claims Database Analysis
Seung Hoon Kim, Suk‐Yong Jang, Yonghan Cha, Hajun Jang, Bo-Yeon Kim, Hyo-Jung Lee, Gui-Ok Kim
Abstract
Background:The purpose of our study was to analyze the effects of hospital volume and region on in-hospital and long-term mortality, direct medical costs (DMCs), and length of hospital stay (LOS) in elderly patients following hip fracture, utilizing nationwide claims data. Methods:This retrospective nationwide study sourced its subjects from the Korean National Health Insurance Review and Assessment Service database spanning from January 2011 to December 2018.A generalized estimating equation model with a Poisson distribution and logarithmic link function was used to estimate adjusted odds ratios (aORs) and 95% CIs to assess the association of hospital volume with in-hospital and 1-year mortality, DMCs, and LOS .Results: A total of 172,144 patients were included.Comparing the risk of in-hospital death between high-volume and low-volume hospitals, the risk of in-hospital death was 1.2 times higher at low-volume hospitals (aOR, 1.20; 95% CI, 1.07-1.33;p = 0.002).Additionally, the risk of death at 1 year was 1.05 times higher at low-volume hospitals (aOR, 1.05; 95% CI, 1.01-1.09;p = 0.008) compared to high-volume hospitals.DMCs were 0.84 times lower at low-volume hospitals for in-hospital period (aOR, 0.84; 95% CI, 0.84-0.85;p < 0.001) and 0.87 times lower for 1 year (aOR, 0.87; 95% CI, 0.86-0.88;p < 0.001) compared to high-volume hospitals.In-hospital LOS was 1.21 times longer at low-volume hospitals (aOR, 1.21; 95% CI, 1.20-1.22;p < 0.001) than at high-volume hospitals.In addition, the risk of in-hospital death was 1.22 times higher (aOR, 1.22; 95% CI, 1.12-1.33;p < 0.001) and the risk of 1-year death was 1.07 times higher (aOR, 1.07; 95% CI, 1.04-1.10;p < 0.001) at rural hospitals compared to urban hospitals.Conclusions: Clinicians should focus on improving clinical outcomes for hip fracture patients in low-volume and rural hospital settings, with a specific emphasis on reducing mortality rates.