@article{0481397812cd4aca910f08395c5a5804,
title = "A comparison of outcomes between Canada and the United States in patients recovering from hip fracture repair: Secondary analysis of the FOCUS trial",
abstract = "Objective: To determine if adjusted mortality, walking ability or return home differed after hip fracture surgery between Canada and the USA. Design: Secondary analysis of the Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data. Setting: Data were collected from 47 American and Canadian hospitals. Participants: Overall, 2016 subjects with a hip fracture (USA = 1222 (60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive transfusion strategy. Subjects were 50 years and older, with cardiovascular disease and/or risk factors and hemoglobin <100 g/L within 3 days post-surgery. The average age was 82 years and 1527(76%) subjects were females. Intervention: Demographics, health status and health services data were collected up to 60 days post-surgery and mortality to a median of 3 years post-surgery. Main outcomes: Mortality, inability to walk and return home. Results: US subjects had higher adjusted mortality than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval: 1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio = 1.25; 1.07-1.45). There were no differences in adjusted outcomes for walking ability or return home at 30 or 60 days post-surgery. Median hospital length of stay was longer (P < 0.0001) in Canada (9 days; interquartile range: 5-18 days) than the US (3 days; 2-5 days). US subjects (52.9%) were more likely than Canadians (16.8%) to be discharged to nursing homes for rehabilitation (P < 0.001). Conclusions: Adjusted survival favored Canadians post hip fracture while walking ability and return home were not different between countries. The reason(s) for mortality differences warrant further investigation.",
keywords = "Health services, Hip fracture, Mortality, Patient outcomes",
author = "Beaupre, {Lauren A.} and Wai, {Eugene K.} and Hoover, {Donald R.} and Helaine Noveck and Roffey, {Darren M.} and Cook, {Donald R.} and Magaziner, {Jay S.} and Carson, {Jeffrey L.}",
note = "Funding Information: This work was supported in part by grants from the National Heart, Lung, and Blood Institute (U01 HL073958, U01 HL074815). The data analysis presented in this article, although using the database established by Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS), was a pre-specified analysis of the FOCUS protocol. No formal funding for this analysis was received from any source. L.A.B. receives salary support from the Canadian Institutes of Health Research as a New Investigator and from the Faculty of Rehabilitation Medicine as the David Magee Endowed Chair in Musculoskeletal Research. J.S.M. reports grants from National Heart Lung and Blood Institute and National Institute on Aging during the conduct of the study; he also received consulting fees while conducting and preparing the paper for this study from: Ammonett, American Orthopaedic Association, Eli Lilly, Novartis, Pluristem, Sanofi, Scholar Rock Viking, and a grant from Eli Lilly. D.M.R. reports working as a consultant for Palladian Health. Funding Information: 1Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada,2Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada, 3Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada, 4Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada, 5Department of Statistics and Biostatistics, Rutgers University, The State University of New Jersey, 473 Hill Center, Busch Campus Rutgers University 110 Frelinghuysen Road Piscataway, NJ 08854-8019, USA, 6Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, 125 Paterson St, New Brunswick, NJ 08901, USA, 7Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada, and 8Department of Epidemiology and Public Health, University of Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood Street, Baltimore, MD 21201, USA Publisher Copyright: {\textcopyright} The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved.",
year = "2018",
month = mar,
day = "1",
doi = "10.1093/intqhc/mzx199",
language = "English (US)",
volume = "30",
pages = "97--103",
journal = "Quality Assurance in Health Care",
issn = "1353-4505",
publisher = "Oxford University Press",
number = "2",
}