Canadian researchers have confirmed a troubling trend: the smaller the hospital, the worse a patient’s chance of surviving a hip fracture.
Some 30,000 hip fractures are reported in Canada every year, and about one of 10 patients die in hospital. A study published Monday in the Canadian Medical Association Journal shows that where patients are treated can affect their chances of surviving.
Researchers tracked more than 168,000 elderly patients and found a higher number of patients died in small- and medium-sized hospitals than larger, teaching hospitals.
“Having such a stark difference between teaching sites and community sites troubles me because it means that we need to do some work and take the measures to improve the care," one of the study’s co-authors Dr. Pierre Guy told CTV from Vancouver. The University of British Columbia associate professor of orthopedics said he hopes the study will be a “call to action.”
The report found that for every 1,000 patients admitted to medium-sized hospitals, 14 more died than those admitted to teaching hospitals. There were 43 more deaths in smaller hospitals with fewer than 50 beds. For every 1,000 patients who undergo surgery, 11 more died at medium community hospitals.
The study doesn’t pinpoint why there is a gap in death rates but researchers worry fewer staff and resources in smaller and mid-sized hospitals may be putting lives at risk.
In the elderly, hip fractures occur as frequently as common cancers but with “severely worse outcomes,” said Dr. Katie Sheehan from UBC’s School of Population and Public Health in a statement.
Even after treatment, 30 per cent of patients die within a year, 25 per cent never walk again and 22 per cent never live independently. Sheehan said these figures have not changed in the past 15 years.
Each hip fracture costs the health-care system $21,285 in the first year after hospitalization, according to Osteoporosis Canada. The cost rises to $44,156 if the patient is institutionalized. The organization says osteoporotic hip fractures consume more hospital bed days than strokes, diabetes, or heart attacks.
The study raises questions about whether it is better to pour resources into smaller hospitals or find better ways of transferring hip fracture patients out to bigger hospitals.
Dr. Peter Cram, an internal medicine specialist at the University Health Network in Toronto, said the data leaves families with a difficult choice.
“If I break my hip and I live in rural area of Manitoba or Saskatchewan should I try to get to a bigger hospital?”
Researchers say surgery wait times, resource availability and organization of care should be investigated further to determine what accounts for differences in survival rates.
With files from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip
