Table 4.
Multivariate-adjusted coefficients and 95% CIs for length of hospital stay with macro-level variance
N = 214,601 | model 1 (all patients, N = 214,601) | model 2 (surgery only, N = 159,173) | model 3 (non-surgery only, N = 55,428) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
coef. | 95% C.I. | P value | coef. | 95% C.I. | P value | coef. | 95% C.I. | P value | ||||
Compositional factor | ||||||||||||
Sex | ||||||||||||
Male (reference) | ||||||||||||
Female | −0.23 | −0.44 | − 0.02 | 0.04 | − 0.60 | − 0.77 | − 0.44 | < 0.001 | 0.31 | − 0.34 | 0.96 | 0.35 |
Age Group | ||||||||||||
65–79 (ref.) | ||||||||||||
80–89 | 1.52 | 1.31 | 1.74 | < 0.001 | 1.16 | 1.00 | 1.33 | < 0.001 | 2.17 | 1.49 | 2.86 | < 0.001 |
Over 90 | 0.85 | 0.58 | 1.11 | < 0.001 | 0.92 | 0.72 | 1.13 | < 0.001 | 1.32 | 0.52 | 2.12 | < 0.001 |
Dementia Levela | ||||||||||||
No dementia (ref.) | ||||||||||||
Dementia level 1 | 0.67 | 0.44 | 0.89 | < 0.001 | 0.21 | 0.04 | 0.39 | 0.02 | 1.96 | 1.28 | 2.63 | < 0.001 |
Dementia level 2 | −1.70 | −1.96 | − 1.44 | < 0.001 | −1.50 | − 1.70 | − 1.30 | < 0.001 | −0.56 | − 1.34 | 0.22 | 0.16 |
Fx. Type | ||||||||||||
Femoral neck (ref.) | ||||||||||||
Trochanteric | 0.24 | 0.06 | 0.42 | 0.01 | −0.56 | −0.70 | − 0.42 | < 0.001 | 2.38 | 1.84 | 2.93 | < 0.001 |
Subtrochanteric | 3.57 | 2.82 | 4.32 | < 0.001 | 3.00 | 2.35 | 3.66 | < 0.001 | 5.68 | 3.84 | 7.53 | < 0.001 |
Charlson Index | ||||||||||||
0 (ref.) | ||||||||||||
1 | 1.03 | 0.82 | 1.24 | < 0.001 | 0.97 | 0.81 | 1.13 | < 0.001 | 1.39 | 0.73 | 2.06 | < 0.001 |
≥ 2 | 2.32 | 2.09 | 2.55 | < 0.001 | 2.46 | 2.28 | 2.64 | < 0.001 | 2.55 | 1.84 | 3.26 | < 0.001 |
Coma Levelb | ||||||||||||
Alert (ref.) | ||||||||||||
Level 1 | −0.94 | −1.23 | − 0.66 | < 0.001 | − 0.36 | − 0.57 | −0.14 | < 0.001 | − 1.43 | −2.31 | − 0.54 | < 0.001 |
Level 2 | − 0.42 | −1.71 | 0.88 | 0.53 | 0.22 | −0.82 | 1.25 | 0.68 | 0.21 | −3.45 | 3.86 | 0.91 |
Level 3 | −3.14 | −7.81 | 1.53 | 0.19 | 0.72 | −3.31 | 4.76 | 0.73 | −8.37 | −19.80 | 3.06 | 0.15 |
Ambulance Use | ||||||||||||
No ambulance use (ref.) | ||||||||||||
Ambulance use | 1.05 | 0.87 | 1.24 | < 0.001 | 1.94 | 1.80 | 2.08 | < 0.001 | −1.47 | −2.10 | −0.84 | < 0.001 |
Contextual factor | ||||||||||||
City levelc | ||||||||||||
Designated city (ref.) | ||||||||||||
Pop. ≥150,000 | −0.02 | −1.58 | 1.53 | 0.98 | −2.53 | −3.78 | −1.27 | < 0.001 | 0.95 | −1.00 | 2.90 | 0.34 |
Pop. 80,000≤, ≤150,000 | 0.25 | −1.68 | 2.19 | 0.80 | −1.96 | −3.53 | −0.39 | 0.02 | 0.68 | −1.72 | 3.08 | 0.58 |
Pop. ≤80,000 | 1.51 | −0.19 | 3.21 | 0.08 | −0.15 | −1.56 | 1.25 | 0.83 | 1.85 | −0.25 | 3.96 | 0.09 |
Hosp. functiond | ||||||||||||
Under 200 beds hosp.(ref.) | ||||||||||||
Over 200 beds hosp. | −7.87 | −9.26 | −6.47 | < 0.001 | −4.13 | −5.37 | −2.89 | < 0.001 | −8.42 | −10.14 | −6.70 | < 0.001 |
Regional support hosp. | −12.04 | − 13.98 | − 10.09 | < 0.001 | −9.02 | − 10.68 | − 7.35 | < 0.001 | − 12.61 | − 15.01 | − 10.22 | < 0.001 |
University & advanced hosp. | − 15.69 | −18.50 | − 12.87 | < 0.001 | − 10.41 | − 12.75 | −8.08 | < 0.001 | − 17.79 | − 21.77 | − 13.82 | < 0.001 |
Discharge to | ||||||||||||
Home (ref.) | ||||||||||||
Recovery ward (same hosp.) | −22.33 | −22.88 | − 21.78 | < 0.001 | −15.66 | −16.18 | − 15.13 | < 0.001 | −27.83 | − 29.06 | − 26.60 | < 0.001 |
Other hospital | −5.95 | −6.19 | −5.71 | < 0.001 | − 2.60 | − 2.79 | − 2.40 | < 0.001 | −15.82 | − 16.60 | − 15.04 | < 0.001 |
Long-term care facility | −5.95 | − 6.24 | − 5.66 | < 0.001 | − 5.05 | − 5.29 | − 4.81 | < 0.001 | − 4.79 | − 5.56 | − 4.01 | < 0.001 |
Death | 1.46 | 0.66 | 2.26 | < 0.001 | − 1.93 | −2.62 | −1.25 | < 0.001 | 8.47 | 6.48 | 10.46 | < 0.001 |
Unknown | −2.75 | −5.25 | −0.24 | 0.03 | −1.04 | −3.13 | 1.06 | 0.33 | −4.30 | −10.74 | 2.14 | 0.19 |
Macro-level variance (S.E.) | ||||||||||||
between hospitals | 116.1 | (5.30) | 75.3 | (3.70) | 136.8 | (7.27) |
aDementia level 1 and 2: represents “degree of independence in daily life for elderly people with dementia” criteria I-II and III-IV/M, respectively. bComa level refers to the Japan Coma Scale (JCS) which has four decisive levels of consciousness. cDesignated city has population over 500,000 and is designated by order of the Cabinet of Japan under Local Autonomy Law. dAdvanced hospitals include 6 national centers for cancer, circulation and global health. Regional support hospital has over 200 beds and meets requirements such as referral rate over 80% for outpatients