Skip to main content

Table 3 Reported associations between patient or clinical characteristics with risk of hospital re-presentations

From: Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis

Study Patient characteristics Association Clinical/service characteristics Association Percentage of re-presentations
Readmission a within 30 days
Readmission within 7 days from discharge
Tsai (2013) [47] Hospitalization for all reasons OR = 0.48 (0.32–0.72) Not investigated   Hospitalization for all reasons: 3.44 %
Fracture related diagnoses OR = 0.28 (0.12–0.68) Fracture related diagnoses: 0.69 %
Musculoskeletal disorder OR = 0.08 (0.01–0.88) Musculoskeletal disorders: 0.20 %
Hospitalization for other diagnoses OR = 0.67 (0.41–1.09) Hospitalization for other diagnoses: 2.55 %
Readmission within 14 days from discharge
Jou et al. (2014) [24] 14 days:   14 days: Medical center Referent 50–74 y (3.21 %)
Age < 75 Age ≥ 75 Referent Regional hospital
District hospital
HR = 1.56 (1.08–2.25)
HR = 1.36 (1.08–1.71) HR = 4.47 (3.20–6.26)
14 days:
CCI score 0
CCI score ≥ 2
  LOS
≤10 days
≥11 days
  ≥75 y (4.16 %)
Referent Referent
HR = 1.52 (1.22–1.92) HR = 0.25 (0.19–0.34)
14 days: Geographic regions  
Northern
Central
Southern
Eastern
Referent
HR = 1.21 (0.89–1.64)
HR = 1.17 (0.89–1.54)
HR = 0.96 (0.47–1.96)
Readmission within 28 days from discharge
Khan et al. (2012) [36] Age OR = 1.06 (1.02–1.10) Not investigated   11 %
Diabetes OR = 3.34 (1.54–7.25)
History of neurological disorders OR = 5.66 (2.79–11.47)
Admission other than home OR = 2.36 (1.19–4.66)
Readmission within 30 days from discharge
Boddaert et al. (2014) [21] CIRS score RR = 1.08 (1.00–1.16) Intervention vs. control group RR = 0.40 (0.23–0.70) Orthopedic group (usual care) = 17 %
Age RR = 0.99 (0.95–1.03)    Geriatric group (intervention) = 5 %
Male sex RR = 0.76 (0.41–1.41)
French et al. (2008) [25] Chronic heart failure OR = 1.24 (1.16–1.33) Inpatient LOS OR = 1.01 (1.01–1.02) 18 %
Cardiac arrhythmias OR = 1.11 (1.04–1.17) 30 % occurred in the first week
Other neurological disorder OR = 1.15 (1.05–1.26) 60 % within 2 weeks
Chronic pulmonary disease OR = 1.33 (1.25–1.40) 81 % within 3 weeks
Diabetes mellitus without chronic
complication
 
OR = 1.32 (1.15–1.52)
Renal failure OR = 1.43 (1.29–1.60)
Coagulopathy OR = 1.33 (1.16–1.52)
Weight loss OR = 1.24 (1.07–1.44)
Fluid and electrolyte disorders OR = 1.11 (1.04–1.20)
Deficiency anemia OR = 1.16 (1.09–1.25)
Alcohol abuse OR = 0.86 (0.75–0.98)
Psychosis OR = 1.16 (1.00–1.34)
Depression OR = 1.06 (0.95–1.18)
Heidari et al. (2012) [26] Not investigated   Hospital drug policy for chemical thromboprophylaxis   55 %
Aspirin OR = 1.03 (0.87–1.23)
Heparin drug policy OR = 1.06 (0.97–1.16)
Low-dose heparin OR = 1.09 (0.93–1.28)
Jou et al. (2014) [24] 30 days:   30 days: Medical center Referent 50–74 y (3.21 %) ≥75 y (4.87 %)
Age < 75 Age ≥ 75 Referent Regional hospital
District hospital
HR = 1.51 (1.10-2.09)
HR = 1.34 (1.07–1.62) HR = 3.82 (2.83–5.14)
30 days:   LOS  
CCI score 0
CCI score ≥ 2
Referent ≤10 days
≥11 days
Referent
HR = 1.60 (1.30–1.97) HR = 0.32 (0.25–0.41)
30 days: Geographical regions  
Northern
Central
Southern
Eastern
Referent
HR = 1.25 (0.94–1.67)
HR = 1.20 (0.93–1.54)
HR = 1.00 (0.52–1.92)
Kates et al. (2014) [28] Age > 85 OR = 1.52 (1.02–2.26) Time to surgery > 24 h OR = 1.50 (1.00–2.25) 11 %
CCI ≥ 4 OR = 1.70 (1.02–2.81)
Delirium OR = 1.65 (1.13–2.40)
Dementia OR = 1.61 (1.12–2.33)
History of arrhythmia with pacemaker OR = 1.75 (1.11–2.76)
Placement presence of a pre-op arrhythmia OR = 1.62 (1.09–2.39)
Partial or complete disability with ADL OR = 1.54 (1.05–2.26)
Kates et al. (2015) [49] Age > 85 OR = 1.58 (1.02–2.26) Not investigated   11.9 %
Male OR = 1.49 (1.00–2.24)
Assisted living OR = 1.52 (0.82–2.59)
Skilled nursing OR = 1.24 (0.84–1.85)
Parker mobility medium (5–8) OR = 1.81 (0.98–3.35)
Parker mobility low (0–4) OR = 1.50 (0.85–2.64)
Charlson score medium (2–3) OR = 1.51 (1.03–2.25)
Charlson score high (4 or more) OR = 1.65 (1.00–2.74)
Partial or complete disability OR = 1.51 (1.03–2.25)
Delirium OR = 1.66 (1.14–2.41)
Preoperative arrhythmia OR = 1.62 (1.09–2.39)
Hematoma OR = 7.51 (0.47–1.21)
Urinary tract infection OR = 1.84 (0.39–8.84)
Pacemaker OR = 1.75 (1.11–2.76)
Diabetes OR = 1.91 (1.22–2.99)
Dementia OR = 1.61 (1.12–2.22)
GERD OR = 1.44 (0.99–2.10)
Cardiac disease OR = 1.02 (0.66–1.59)
Alcoholism OR = 1.12 (0.46–2.68)
Tobacco use OR = 0.99 (0.56–1.73)
Le-Wendling et al. (2012) [37] Not investigated   Local vs. general anesthetic OR = 2.0 (1.0-4.0) 19 %
Pollock et al. (2015) [50] Pre-existing pulmonary disease OR = 1.88 (1.30–2.72) Discharge to skilled nursing facility OR = 1.5 (1.04–2.14) 9 %
Hospital LOS > 8 days OR = 1.88 (1.30–2.72)
Toson et al. (2015) [53] Myocardial infarction OR = 1.1 (1.0–1.2) Not investigated   16 %
Congestive heart failure OR = 1.2 (1.1–1.3)
Peripheral vascular disease OR = 1.2 (1.0–1.3)
Cerebrovascular accident OR = 1.1 (1.0–1.2)
Dementia OR = 0.8 (0.8–0.9)
Chronic pulmonary disease OR = 1.1 (1.0–1.2)
Connective tissue disorder OR = 1.2 (1.0–1.4)
Peptic ulcer OR = 1.2 (1.0–1.5)
Mild liver disease OR = 1.3 (1.0–1.7)
Diabetes without chronic
complications
 
OR = 1.1 (1.0–1.2)
Diabetes with chronic complications OR = 1.2 (1.1–1.3)
Hemiplegic or paraplegia OR = 0.9 (0.8–1.1)
Renal disease OR = 1.3 (1.2–1.5)
Any malignancy OR = 1.4 (1.2–1.6)
Metastatic solid tumor OR = 1.1 (0.9–1.4)
Moderate or severe liver disease OR = 5.0 (3.3–7.5)
Readmission within 30 days post-operative
Basques et al. (2015) [30] Age ≥ 90 OR = 1.35 (1.09–1.67) Discharge to a facility OR = 1.42 (1.08–1.86) 10 %
Male OR = 1.40 (1.20–1.63) ASA class 3 OR = 1.40 (1.09–1.69)
BMI ≥ 35 OR = 1.73 (1.24–2.44) ASA class 4 OR = 1.90 (1.44–2.51)
History of pulmonary disease OR = 1.46 (1.22–1.75)   
Hypertension OR = 1.21 (1.02–1.45)
Steroid use OR = 1.38 (1.04–1.83)
Partially dependent functional status OR = 1.31 (1.11–1.54)
Fully dependent functional status OR = 1.41 (1.01–1.97)
Golinvaux (2014) [48] Non-insulin dependent diabetes mellitus   Not investigated   Without diabetes = 5 %, Non-insulin dependent diabetes mellitus = 7 %,
  RR = 1.4 (1.0–2.0)    Insulin dependent diabetes mellitus = 7 %
Insulin-dependent diabetes mellitus RR = 1.4 (0.9–2.2)
Hageman et al. (2014) [43] CCI and age OR = 1.1, P < 0.01, R2 = 0.03 Not investigated   2 % readmitted without surgical adverse event
4 % readmitted with surgical adverse event
Ling et al. (2013) [19] Age 60–70 Referent Not investigated   9 %
Age 70–80 OR = 1.60 (0.31–8.22)
Age 80–90 OR = 3.91 (0.83–18.4)
Age > 90 OR = 7.21 (1.28–40.65)
Female Referent
Male OR = 0.75 (0.27–2.10)
Intertrochanteric OR = 0.84 (0.36–1.95)
Comorbidity = 0 Referent
Comorbidity > 1 OR = 0.73 (0.26–2.04)
Comorbidity > 2 OR = 0.48 (0.10–2.26)
Comorbidity > 3 OR = 1.53 (0.45–5.19)
Renal failure OR = 2.49 (0.50–12.4)
Serum albumin OR = 2.09 (0.69–6.36)
Serum iPTH OR = 1.01 (0.42–2.47)
Vitamin D deficiency OR = 1.00 (0.43–2.33)
Euthyroid Referent
Overt hypothyroidism OR = 1.75 (0.35–8.89)
Thyroid dysfunction OR = 1.19 (0.47–3.03)
Subclinical hypothyroidism OR = 0.44 (0.05–3.54)
Radcliff (2008) [51] White race OR = 1.32 Plate/screw (CPT 27244) OR = 1.26 7 %
Age 65–74 Referent Open reduction (CPT 27236) OR = 1.13
Age 75–84 OR = 1.17 Hemiarthroplasty (CPT 27125) OR = 1.30
Age ≥ 85 OR = 0.95 Percutaneous fixation (CPT 27235) OR = 1.05
Currently smoking OR = 0.94 Intramedullary implant (CPT 27245) OR = 0.92
Alcohol use (>2 drinks/day) OR = 1.29 General anesthesia OR = 0.97
Partial independence OR = 1.04 Blood transfusion (1 U) OR = 1.01
Total independence OR = 0.70 Surgery 4 days after admission OR = 0.70
Impaired sensorium OR = 1.67 Weekend surgery OR = 1.15
Renal insufficiency OR = 1.46 Wound not “clean” OR = 1.44
Steroid use OR = 1.10 Emergency admission OR = 0.74
Disseminated cancer OR = 0.87 ASA class 3 OR = 1.38
Congestive heart failure OR = 1.28 ASA class 4 or 5 OR = 1.60
Dementia OR = 0.75
Diabetes OR = 1.09
Hemiplegia OR = 1.02
Severe chronic obstructive pulmonary disease OR = 1.24
Recent weight loss OR = 0.99
Hyponatremia OR = 1.73
Toy et al. (2014) [41] History of pulmonary disease OR = 2.0 Inpatient status before procedure OR = 1.9 10.8 %
Tsai (2013) [47] Hospitalization for all reasons OR = 0.74 (0.59–0.93) Not investigated   Hospitalization for all reasons: 14.73 %
Fracture related diagnoses OR = 0.69 (0.45–1.05) Fracture-related diagnoses: 3.73 %
Musculoskeletal disorders OR = 0.60 (0.37–0.98) Musculoskeletal disorders: 2.36 %
Hospitalization for other diagnoses OR = 0.83 (0.62–1.12) Hospitalization for other diagnoses: 9.23 %
Readmission to hospital within 30 days of admission to nursing home
Kiel et al. (1994) [45] Age 74–85 OR = 0.58 (0.40–0.83) Not investigated   12.4 %
Age > 85 OR = 0.55 (0.38–0.80)
Secondary neurological diagnoses OR = 0.75 (0.56–1.00)
Living with someone OR = 1.44 (1.12–1.87)
Any dependency in ADLs OR = 1.45 (1.08–1.93)
Ability to walk OR = 1.54 (1.16–2.05)
Readmission >30 days
Readmission to hospital within 60 days from discharge
Halm et al. (2003) [27] Active clinical issue in the 24 h before discharge OR = 1.6 (1.0–2.6) Not investigated   18.8 %
New impairment in the 24 h before discharge OR = 1.7 (1.2–2.3)
Halm et al. (2003) [33] Transfusion when Hb < 10.0 g/dL OR = 0.52 (0.28–0.97)    16.9 %
Halm et al. (2004) [34] Hb on admission OR = 0.69 (0.49–0.95) Not investigated   16.9 %
Hb lowest preoperative OR = 0.65 (0.48–0.89)
Hb lowest postoperative OR = 0.78 (0.64–0.95)
Readmission within 80 and 180 days
Ottenbacher et al. (2003) [46] Age Beta = 0.943, SEM = 0.374, LR = 3.51 Not investigated   16.7 %
Ethnicity × gender Beta = 0.012, SEM = 0.005, LR = 2.54
FIM rating Beta = −0.825, SEM = 0.293, LR = 4.86
Readmission within 90 days from discharge
Vochteloo et al. (2011) [22] Age OR = 0.97 (0.94-0.99) ASA OR = 1.43 (0.99–2.09) Anemic group 12.9 %, Non-anemic group 9.0 %
Anemia RR = 1.24 (1.04–1.49) General anesthesia OR = 0.35 (0.13–0.99)
Readmission 90 days from surgery
Zhang et al. (2014) [52] Male HR = 0.77 (0.72–0.83) Hemiarthroplasty HR = 0.77 (0.71–0.83) 90 day readmission rate = 14 %
African-American race HR = 1.22 (1.02–1.46) RTSA HR = 0.82 (0.67–0.99) 15 % for open reduction-internal fixation and RTSA
Medical comorbidities (per diagnosis) HR = 1.20 (1.18–1.22)   13 % for hemiarthroplasty
Insurance with Medicaid HR = 1.27 (1.08–1.49)
Private insurance HR = 0.82 (0.74–0.91)
Discharge status – home with services HR = 1.19 (1.07–1.32)
Transfer to facility nursing or rehab HR = 1.99 (0.82–2.18)
Gregersen et al. (2011) [42] Postop Hb levels ≤ 6 mmol/L OR = 3.24 (1.15–9.14) Intervention care OR = 0.47 (0.23–0.94) 14 % intervention care
Age OR = 2.98 (1.08–8.21) 26 % standard care
Readmission within 180 days from surgery
Tsai (2013) [47] Hospitalization for all reasons OR = 0.93 (0.78–1.38) Not investigated   Hospitalization for all reasons: 38.31 %
Fracture related diagnoses OR = 0.90 (0.67–1.21) Fracture related diagnoses: 9.14 %
Musculoskeletal disorders OR = 1.03 (0.77–1.38) Musculoskeletal disorders: 9.43 %
Hospitalization for other diagnoses OR = 0.93 (0.77–1.13) Hospitalization for other diagnoses: 26.72 %
Readmissions within 6 months from discharge
Härstedt et al. (2015) [35] Hypertension OR = 2.0 (1.2–1.9) Not investigated   32 %
Atrial Fibrillation OR = 0.80 (0.40–1.61)    73 % were admitted once only
Myocardial infarction OR = 0.70 (0.30–1.64)
Angina pectoris OR = 0.49 (0.19–1.26)
Heart failure OR = 0.69 (0.29–1.61)
Pacemaker OR = 6.64 (1.68–26.33)
Valvular heart disease OR = 0.87 (0.17–4.60)
Syncope OR = 0.99 (0.36–2.71)
Stroke OR = 0.66 (0.31–1.40)
Pulmonary embolism/deep vein thrombosis OR = 2.72 (0.80–9.24)
Peripheral vascular disease OR = 1.01 (0.33–3.08)
Parkinson’s disease OR = 1.32 (0.32–5.70)
Epilepsy OR = 0.26 (0.03–2.15)
Cognitive disorder (dementia) OR = 1.68 (0.94–3.01)
Depression OR = 1.54 (0.63–3.78)
Diabetes mellitus OR = 0.64 (0.29–1.42)
Thyroid disease OR = 1.47 (0.70–3.12)
Respiratory disease (COPD) OR = 0.98 (0.42–2.26)
Malignancy OR = 1.16 (0.57–2.37)
Autoimmune disorders OR = 2.30 (0.87–6.10)
Prostate tumor (men) OR = 4.99 (0.92–27.18)
Previous fracture OR = 1.70 (0.86–3.36)
Osteoporosis OR = 0.30 (0.07–1.40)
Diseases in the kidney and urinary
tract
 
OR = 1.72 (0.57–5.16)
Anemia OR = 1.19 (0.43–3.32)
ASA classification per one grade OR = 1.67 (0.99–2.80)
Riggs et al. (2010) [39] Discharge to rehabilitation Standard coeff −0.095 (−0.102 to −0.11) LOS 75th quartile ≥ 9 days) Standard coefficient 0.151 (0.044–0.141) 8.3 %
Any days in Intensive Care Unit Standard coefficient 0.168 (0.097–0.271)
Readmission after 12 months from discharge
Bischoff- Ferrari (2010) [20]    2000- vs. 800-IU/d dosage of cholecalciferol Relative rate different, −39 % (−62 % to −1 %) 70 % had 1 readmission, 22 % had 2 readmissions and 7 % had 3 readmissions
Efficacy analysis: 2000 IU/d dose Relative rate different, −55 % (−79 % to −2 %)
Giusti et al. (2008) [32] Age 76–85 OR = 0.77 (0.29–2.01) Not investigated   30.1 %
Age > 85 OR = 0.46 (0.16–1.29)
CIRS-SI 1.5–1.9 OR = 5.95 (1.66–21.3)
CIRS-SI > 1.9 OR = 7.05 (1.68–29.7)
2 month ADL Katz Index 0–2 OR = 3.02 (1.09–8.32)
Heyes et al. (2015) [29] Female OR = 1.34 (0.65–2.76) Time to surgery 36 h to 6 days OR = 1.62 (0.156–2.44) 44 %
Cephalomedullary nail OR = 1.51 (0.40–1.08) >6 days OR = 1.29 (0.198–3.02)
Hip hemiarthroplasty/THR OR = 3.10 (0.19–1.80) Inpatient stay > 7 days OR = 3.13 (0.12 –0.62)
Moderate alcoholic OR = 1.36 (0.31–1.73) Inpatient stay of 7–14 days OR = 7.04 (0.05 –0.34)
Alcoholic OR = 1.52 (0.26–1.66) Inpatient stay of 14–21 days OR = 2.90 (0.18 –0.64)
Affected side-right OR = 1.10 (0.57–1.45) Inpatient stay of 21–28 days OR = 1.83 (0.25–0.16)
Ex-smoker OR = 1.14 (0.64–2.00) Inpatient stay of 28–35 days OR = 2.11 (0.19–1.17)
Smoker OR = 1.24 (0.56–2.72) ASA score > 2 OR = 3.68 (0.06–1.15)
Residential care/nursing home residence OR = 1.71 (1.34–1.98) ASA score > 3 OR = 1.95 (0.17–1.48)
ASA score > 4 OR = 2.14 (0.16–1.33)
Hb > 2 g/dL drop OR = 1.29 (0.48–1.24) Transfusion status < 2 units OR = 1.12 (0.31–4.00)
Admission glucose > 7.8 mmol/L OR = 1.18 (0.66–2.09) Transfusion status > 2 units OR = 1.85 (0.48–7.04)
Discharge glucose > 7.8 mmol/L OR = 1.05 (0.53–1.70)
Total protein OR = 1.13 (0.53–1.46)
Admission eGFR < 45 OR = 1.04 (0.50–1.83)
Discharge eGFR < 45 OR = 1.04 (0.47–1.96)
Hsaio et al. (2011) [23] Long-term use of alendronate reduces risk HR = 0.27 (0.15–0.78) Not investigated   8.6 % cases untreated cohort; 6.3 % alendronate users; 7.6 % other anti organophosphorous drug users
Intrator et al. (1998) [44] Home healthcare usage OR = 0.77 (0.52–1.15) Not investigated   Rehab only group 34.1 % Rehab and home health group 27.2 %
Jou et al. (2014) [24] 1 year:   1 year: District hospital HR = 2.24 (1.82–2.75) 50–74 y (6.02 %)
Age < 75
Age ≥ 75
Referent LOS   ≥75 y (8.38 %)
HR = 1.46 (1.24–1.73) ≤10 days
≥11 days
Referent
1 year: CCI = 0
CCI score ≥ 2
Referent HR = 0.51 (0.43–0.60)
HR = 1.28 (1.09–1.51) 1 year: Geographic regions  
Northern
Central
Southern
Eastern
Referent
HR = 1.12 (0.90–1.39)
HR = 1.07 (0.88–1.29)
HR = 0.89 (0.54–1.46)
Merchant (2005) [38] Post-operative complications After adjustment for potential covariates the presence of postoperative complications was not significant (P > 0.05, coefficients not presented) Not investigated   31.7 %
Teixeira et al. (2009) [40] Male (predicts related first readmission) HR = 1.25 (1.08–1.46) Teaching hospital vs. public hospital (predicts related first readmission)   32 %
Male HR = 1.36 (1.16–1.59) HR = 0.86 (0.79–0.95)
Increasing age (predicts unrelated first readmission) HR = 0.94 (0.89–0.99) Index stay in a private hospital HR = 0.78 (0.67–0.9)
Cancer HR = 1.41 (1.03–1.94) Teaching hospital (predicts unrelated first readmission) HR = 0.87 (0.79–0.95)
Kidney disease HR = 1.38 (1.00–1.90)
Dementia (predicts related first readmission) HR = 1.21 (1.01–1.46)
Dementia (predicts unrelated first readmission) HR = 0.68 (0.53–0.87)
Readmission within 18 months from discharge
Fox et al. (1998) [31] Performance on balance tests at 2 months post fracture Beta = −0.155, P= 0.01    
Gait score Beta = −0.013, P = 0.83
Mobility score Beta = −0.098, P = 0.11
  1. CCI, Charlson comorbidity index; CIRS, Cumulative illness rating scale – severity index; ASA, American Society of Anesthesiologists score; LOS, length of stay; ADL, activities of daily living; FIM, functional independence measure; CM, conservative treatment; RTSA, reverse total shoulder arthroplasty; Hb, hemoglobin; HR, hazards ratio; OR, odds ratio; LR, likelihood ratio; RR, relative risk
  2. aThe term readmission is being used as the studies have reported on hospital readmissions rather than hospital re-presentations
  3. Bold text indicates a significant association (p <0.05)