Comparison of care process and patient outcomes after hip-fracture surgery in acute-care hospitals in Japan and the United States

AimTo compare the care processes and outcomes during hospitalisation of hip-fracture patients in Japan and the United States as well as to examine the relationship between care processes, postoperative complications and mortality.MethodsThis was a retrospective multi-site study. Data were collected from three hospitals in Japan and two in the USA. Participants (⩾65 years) had undergone hip-fracture surgery in one of these hospitals from August 2005 to September 2007. A mail survey was conducted for collecting data on outcomes after discharge.ResultsThe number of days before surgery and before initial ambulation after surgery was significantly longer in Japan than in the USA. After adjusting for patient characteristics, the incidence of complications was significantly higher in the USA. General anaesthesia, delayed postoperative day on which patients first got out of bed, and blood transfusions were significantly associated with a higher incidence of complications. The type of surgery and delayed postoperative day on which patients first got out of bed were significantly associated with higher mortality.ConclusionsIncidence of complications was significantly higher in the USA. An extremely short length of hospital stay because of a prospective payment system may degrade the quality of care and patient outcomes.