• Katie J Sheehan, Boris Sobolev, Pierre Guy, Lisa Kuramoto, Suzanne N Morin, Jason M Sutherland, Lauren Beaupre, Donald Griesdale, Michael Dunbar, Eric Bohm, Edward Harvey, and Canadian Collaborative Study of Hip Fractures.
• School of Population and Public Health (Sheehan, Sobolev, Sutherland) and Department of Orthopedics (Guy), University of British Columbia, Vancouver, BC; Centre for Clinical Epidemiology and Evaluation (Kuramoto), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Medicine (Morin), McGill University, Montréal, Que.; Department of Physical Therapy and Division of Orthopaedic Surgery (Beaupre), University of Alberta, Edmonton, Alta.; Department of Anesthesiology, Pharmacology and Therapeutics (Griesdale), University of British Columbia, Vancouver, BC; Division of Orthopaedic Surgery (Dunbar), Dalhousie University, Halifax, NS; Division of Orthopaedic Surgery and Centre for Healthcare Innovation (Bohm), University of Manitoba, Winnipeg, Man.; Division of Orthopaedic Surgery (Harvey), McGill University, Montréal, Que. sheehakj@mail.ubc.ca boris.sobolev@ubc.ca.
• CMAJ. 2016 Dec 6; 188 (17-18): 1219-1225.

BackgroundWhere patients with hip fracture undergo treatment may influence their outcome. We compared the risk of in-hospital death after hip fracture by treatment setting in Canada.MethodsWe examined all discharge abstracts from the Canadian Institute for Health Information with diagnosis codes for hip fracture involving patients 65 years and older who were admitted to hospital with a nonpathological first hip fracture between Jan. 1, 2004, and Dec. 31, 2012, in Canada (excluding Quebec). We compared the risk of in-hospital death, overall and after surgery, between teaching hospitals and community hospitals of various bed capacities, accounting for variation in length of stay.ResultsCompared with the number of deaths per 1000 admissions at teaching hospitals, there were an additional 3 (95% confidence interval [CI] 1-6), 14 (95% CI 10-18) and 43 (95% CI 35-51) deaths per 1000 admissions at large, medium and small community hospitals, respectively. For the risk of in-hospital death overall, the adjusted odds ratios (ORs) were 1.05 (95% CI 0.99-1.11), 1.16 (95% CI 1.09-1.24) and 1.44 (95% CI 1.31-1.57) at large, medium and small community hospitals, respectively, compared with teaching hospitals. For the risk of postsurgical death in hospital, the adjusted ORs were 1.06 (95% CI 1.00-1.13), 1.13 (95% CI 1.04-1.23) and 1.18 (95% CI 0.87-1.60) at large, medium and small community hospitals, respectively.InterpretationCompared with teaching hospitals, the risk of in-hospital death among patients with hip fracture was higher at medium and small community hospitals, and the risk of in-hospital death after surgery was higher at medium community hospitals. No differences were found between teaching and large community hospitals. Future research should examine the role of volume, demand and bed occupancy for observed differences.© 2016 Canadian Medical Association or its licensors.

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