Background
Methods
Data sources
Inclusion and exclusion criteria
Study sample
Mortality measures
-
Death within 30 days after first day of admission, occurring in-and-out-of hospital, including transferred patients by weighting the outcome to each hospital by the fraction of time (within the 30 day period) spent in each hospital (W30D).
-
Death within 30 days after first day of admission, occurring in-and-out-of hospital for patients admitted to one single hospital only (S30D).
-
Death within 30 days after first day of admission, occurring in-hospital only (IH30D). For transferred patients, time to death was counted from first day of each admission, i.e. previous hospitals in the chain of admissions counted the patient as survivor.
W30D†
| S30D‡
| IH30D§
| ||
---|---|---|---|---|
Place of death | In-hospital, during initial admission | Yes | Yes | Yes |
In-hospital during a subsequent admission | Yes | No | Yes | |
Outside hospital | Yes | Yes | No | |
Start for counting number of days | From Day 0 at the initial hospital | Yes | Yes | No |
From Day 0 at each hospital in the chain of admission | No | No | Yes | |
Weight attributed to each hospital | (Days at hospital)/ total hospital days) | Yes | No | No |
Unweighted | No | Yes | Yes | |
Transferred patients included | Yes | Yes | No | Yes |
Statistical analysis
Results
Patient characteristics
AMI∥
| Stroke | Hip fracture | |
---|---|---|---|
Total number of hospitals, N | 55 | 59 | 58 |
Small (hospitals/admissions) | 34/ 17 994 | 38/ 19 933 | 39/ 16 750 |
Large (hospitals/admissions) | 16/ 22 172 | 16/ 21 223 | 15/ 18 588 |
University (hospitals/admissions) | 5/ 9 963 | 5/ 8 925 | 4/ 7 370 |
Total number of patients | 48 048 | 47 854 | 40 142 |
Transferred patients, n (%)*
| 2 463 (5.1%) | 2 293 (4.8%) | 2 649 (6.6%) |
Mean length of stay (range of individual hospitals), days | 8.6 (3.9 - 10.7) | 14.0 (6.3 - 25.0) | 11.8 (5.6 - 30.4) |
Gender, females, n (%)* | 18 238 (38.0%) | 23 814 (49.8%) | 29 801 (74.2%) |
Age, n (%)* | |||
< 50 years | 3 888 (8.1%) | 1 860 (3.9%) | ¤ |
50 – 75 years | 23 993 (49.9%) | 19 209 (40.1%) | 8 074 (20.1%)¤ |
>75 years | 20 167 (42.0%) | 26 785 (56.0%) | 32 068 (79.9%) |
Time to death within 1 year, n (%)* | |||
<30 days | 9 158 (19.1%) | 8 429 (17.6%) | 3 140 (7.8%) |
31 – 90 days | 1 540 (3.2%) | 2 175 (4.5%) | 2 621 (6.5%) |
91 – 365 days | 2 837 (5.9%) | 3 758 (7.9%) | 4 557 (11.4%) |
Alive > 1 year, n (%)* | 34 513 (71.8%) | 33 492 (70.0%) | 29 824 (74.3%) |
Number of deaths within 30 days (% of deaths within 30 days) | |||
during first admission | 7 980 (87.1%) | 6 851 (81.3%) | 1 486 (47.3%) |
in a different hospital | 156 (1.3%) | 191 (2.3%) | 52 (1.7%) |
out-of-hospital | 1 022 (11.1%) | 1 387 (16.5%) | 1 602 (51.0%) |
Number of deaths within 1 year, (% of total deaths within 1 year) | |||
during first admission | 8 188 (60.5%) | 7124 (49.6%) | 1 645 (15.9%) |
in a different hospital | 167 (1.2%) | 212 (1.5%) | 69 (0.7%) |
out-of-hospital | 5 180 (38.3%) | 7026 (48.9%) | 8 604 (83.4%) |
Number of deaths within 1 year caused by referral diagnosis (% of total deaths within 1 year) | 7 859 (58.1%) | 10 535 (73.5%) | 3 863 (37.9%) |
Time to death within 1 year for deaths caused by referral diagnosis (% of total deaths within the interval) | |||
0 – 30 days | 6 757 (73.8%) | 7 550 (89.6%) | 2 383 (75.9%) |
31 – 90 days | 488 (31.7%) | 1 470 (67.6%) | 1000 (38.2%) |
91 – 365 days | 618 (21.8%) | 1 537 (41.0%) | 482 (10.6%) |
Time and place of death
Cause of death
Transferred patients
Transferred to, hospital category | |||||||
---|---|---|---|---|---|---|---|
Small
|
Large
|
University
| |||||
From hospital category | n (%*) | LOS1 / LOS2 days, mean | n (%*) | LOS1 / LOS2 days, mean | n (%*) | LOS1 / LOS2 days, mean | |
AMI | Small | 113 (4.7) | 6.8 / 6.5 | 166 (6.9) | 4.4 / 6.9 | 712 (29.6) | 4.9 / 5.1 |
(n=2404‡) | Large | 383 (15.9) | 7.6 / 8.0 | 113 (4.7) | 4.2 / 8.4 | 614 (25.5) | 5.1 / 3.2 |
University | 129 (5.4) | 4.1 / 6.7 | 165 (6.9) | 3.9 / 5.9 | 9 (0.4) | 8.7 / 14.5 | |
Stroke | Small | 196 (8.9) | 4.9 / 17.6 | 175 (7.9) | 6.3 / 19.0 | 274 (12.4) | 2.3 / 10.9 |
(n=2204‡) | Large | 866 (39.3) | 6.1 / 13.9 | 136 (6.2) | 7.3 / 22.1 | 272 (12.3) | 1.8 / 9.1 |
University | 136 (6.2) | 7.1 / 20.2 | 125 (5.7) | 7.0 / 28.8 | 24 (1.1) | 30.6 / 35.5 | |
Hip fracture | Small | 274 (10.5) | 4.7 / 10.1 | 317 (12.2) | 2.8 / 11.7 | 151 (5.8) | 10.7 / 19.5 |
(n=2600‡) | Large | 1512 (58.2) | 5.5 / 15.1 | 106 (4.1) | 3.9 / 11.0 | 43 (1.7) | 4.3 / 16.4 |
University | 88 (3.4) | 4.3 / 8.9 | 47 (1.8) | 3.3 / 12.1 | 62 (2.4) | 16.2 / 28.9 |
Mortality measures
AMI∥
| Stroke | Hip fracture | |
---|---|---|---|
W30D†
| 18.6 (14.6 – 26.4) | 17.4 (13.6 – 26.7) | 7.6 (1.6 – 12.8) |
S30D‡
| 19.7 (14.6 – 26.6) | 17.9 (10.9 – 27.7) | 8.1 (0 – 33.3) |
IH30D§
| 16.2 (7.0 – 21.7) | 14.1 (6.9 – 21.6) | 3.6 (1.3 – 6.4) |
Rank W30D†
| Rank S30D‡
| Rank IH30D§
| ||
---|---|---|---|---|
AMI∥ (N=55) | Rank W30D | 1.00 | 0.94 | 0.90 |
Rank S30D | 1.00 | 0.82 | ||
Rank IH30D | 1.00 | |||
Mean LOS | 0.05 | −0.11 | 0.15 | |
Stroke (N=59) | Rank W30D | 1.00 | 0.87 | 0.91 |
Rank S30D | 1.00 | 0.78 | ||
Rank IH30D | 1.00 | |||
Mean LOS | −0.22 | −0.22 | 0.05 | |
Hip fracture (N=58) | Rank W30D | 1.00 | 0.81 | 0.66 |
Rank S30D | 1.00 | 0.49 | ||
Rank IH30D | 1.00 | |||
Mean LOS | −0.54 | −0.35 | −0.02 |
S30D‡
| IH30D§
| |||||
---|---|---|---|---|---|---|
High mortality | Medium mortality | Low mortality | High mortality | Medium mortality | Low mortality | |
AMI∥ (N=55), W30D†
| ||||||
High mortality | 8 | 2 | . | 8 | 2 | . |
Medium mortality | 2 | 38 | 4 | 3 | 37 | 4 |
Low mortality | . | . | 1 | . | 1 | . |
Stroke (N=59) , W30D†
| ||||||
High mortality | 12 | 3 | . | 11 | 4 | . |
Medium mortality | 1 | 26 | 3 | 3 | 23 | 4 |
Low mortality | 1 | 1 | 12 | . | 4 | 10 |
Hip fracture (N=58), W30D†
| ||||||
High mortality | . | 14 | . | 5 | 9 | . |
Medium mortality | . | 37 | . | 3 | 34 | . |
Low mortality | . | 7 | . | . | 4 | 3 |