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BACKGROUND Little is known about the effect of preinjury residence on inpatient mortality following hip fracture. This study addressed whether (1) admission from a nursing home residence and (2) admission from another hospital were associated with higher inpatient mortality after a hip fracture. METHODS Using the National Hospital Discharge Survey database, we analyzed an estimated 2 124 388 hip fractures discharges, from 2001 to 2007. Multivariable logistic regression analysis was performed to identify whether admission from a nursing home and admission from another hospital were independent risk factors for inpatient mortality. Our primary null hypothesis is that there is no difference in inpatient mortality rates after hip fracture in patients admitted from a nursing home, compared to other forms of admission. The secondary null hypothesis is that there is no difference in inpatient mortality after hip fracture in patients whose source of admission was another hospital, compared to other sources of admission. RESULTS Almost 4% of the patients were admitted from a nursing home and 6% from another hospital. The mean age was 79 years and 71% were women. The majority of patients were treated with internal fixation. Admission from a nursing home residence (odds ratio [OR] of 2.1, confidence interval [CI] 1.9-2.3) and prior hospital stay (OR 3.4, CI 3.2-3.7) were associated with a higher risk of inpatient mortality after accounting for other comorbidities and type of treatment. CONCLUSIONS Patients transferred to an acute care hospital from a long-term care facility or another acute care hospital are at particularly high risk of inpatient death. This subset of patients should be considered separately from patients admitted from other sources. LEVEL OF EVIDENCE Prognostic level II.

Study Design. Analysis of the National Hospital Discharge Survey database from 1990 to 2007.Objective. To evaluate the influence of preoperative depression, anxiety, schizophrenia or dementia on in hospital (1) adverse events, (2) mortality and (3) non-routine discharge in patients undergoing major spine surgery.Summary of Background Data. Psychiatric comorbidity is a known risk factor for impaired health-related quality of life and poor long-term outcomes following spine surgery, yet little is known about its impact in the perioperative spine surgery setting.Methods. Using the National Hospital Discharge Survey database, all patients undergoing either spinal fusion or laminectomy between 1990 and 2007 were identified and separated into groups with and without psychiatric disorders. Multivariable regression analysis was performed for each of the outcome variables.Results. Between 1990 and 2007, a total estimated number of 5,382,343 spinal fusions and laminectomies were performed. The prevalence of diagnosed depression, anxiety and schizophrenia among the study population increased significantly over time. Depression, anxiety, schizophrenia and dementia were associated with higher rates of non-routine discharge. Depression, schizophrenia and dementia were associated with higher rates of adverse events. Dementia was the only psychiatric disorder associated with a higher risk of in hospital mortality.Conclusion. Patients with preoperative psychiatric disorders undergoing major spine surgery are at increased risk for perioperative adverse events and post hospitalization care, but its effect in perioperative mortality is more limited. Pre-surgical psychological screening of spine surgery candidates might ultimately lead to the enhancement of perioperative outcomes in this growing segment of the US population.