Age Alone Does Not Predict Complications, Length of Stay, and Cost for Patients Older Than 90 Years With Hip Fractures
Abstract
The purpose of this study was to analyze the perioperative complication rate and inpatient hospitalization costs associated with hip fractures in patients older than 90 years compared with patients younger than 90 years. Patients 60 years and older with hip fractures treated operatively at 1 academic medical center between October 2014 and September 2016 were analyzed. Patient demographics, comorbidities, length of stay, procedure performed, and inpatient complications were analyzed. Total cost of admission was obtained from the hospital finance department. Outcomes were compared between patients older than 90 years and patients younger than 90 years. A total of 500 patients with hip fractures were included in this study. There were 109 (21.8%) patients 90 years and older and 391 (78.2%) patients 60 to 89 years. There was no difference in fracture pattern, operation performed, Charlson Comorbidity Index, or length of stay between the 2 groups. The mean length of stay for patients 90 years and older with hip fractures was 7.8±4.3 days vs 7.6±4.2 days for the younger cohort (P=.552). There was no observed difference in perioperative complications. Finally, there was no difference in the total mean cost of admission. Patients 90 years and older are at no greater risk for perioperative complications based on age alone. They are also no more likely to require longer or more costly hospitalizations than patients younger than 90 years. [Orthopedics. 2019; 42(1):e51–e55.]
- 1.Fansa A, Huff S, Ebraheim N. Prediction of mortality in nonagenarians following the surgical repair of hip fractures. Clin Orthop Surg. 2016; 8(2):140–145.
10.4055/cios.2016.8.2.140 Crossref Medline, Google Scholar - 2.Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham study. Am J Public Health. 2002; 92(5):858–862.
10.2105/AJPH.92.5.858 Crossref Medline, Google Scholar - 3.Yelin E, Weinstein S, King T. The burden of musculoskeletal diseases in the United States. Semin Arthritis Rheum. 2016; 46(3):259–260.
10.1016/j.semarthrit.2016.07.013 Crossref Medline, Google Scholar - 4.D';Apuzzo MR, Pao AW, Novicoff WM, Browne JA. Age as an independent risk factor for postoperative morbidity and mortality after total joint arthroplasty in patients 90 years of age or older. J Arthroplasty. 2014; 29(3):477–480.
10.1016/j.arth.2013.07.045 Crossref Medline, Google Scholar - 5.Vochteloo AJ, Borger van der Burg BL, Tuinebreijer WE, Do clinical characteristics and outcome in nonagenarians with a hip fracture differ from younger patients?Geriatr Gerontol Int.2013; 13(1):190–197.
10.1111/j.1447-0594.2012.00885.x Crossref Medline, Google Scholar - 6.Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P. The Charlson Comorbidity Index score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual. 2011; 26(6):461–467.
10.1177/1062860611402188 Crossref Medline, Google Scholar - 7.Shah MR, Aharonoff GB, Wolinsky P, Zuckerman JD, Koval KJ. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma. 2003; 17(suppl 8):6S–11S.
10.1097/00005131-200309001-00003 Crossref, Google Scholar - 8.Manoli A, Driesman A, Marwin RA, Konda S, Leucht P, Egol KA. Short-term outcomes following hip fractures in patients at least 100 years old. J Bone Joint Surg Am. 2017; 99(13):68E.
10.2106/JBJS.16.00697 Crossref, Google Scholar - 9.Miller AG, Bercik MJ, Ong A. Nonagenarian hip fracture: treatment and complications. J Trauma Acute Care Surg. 2012; 72(5):1411–1415.
10.1097/TA.0b013e318246f3f8 Crossref Medline, Google Scholar - 10.Centers for Medicare & Medicaid Services. Bundled Payments for Care Improvement (BPCI) initiative: general information. https://innovation.cms.gov/initiatives/bundled-payments. Accessed March 13, 2018. Google Scholar
- 11.Buntin MB, Colla CH, Deb P, Sood N, Escarce JJ. Medicare spending and outcomes for postacute care for stroke and hip fracture. Med Care. 2010; 48(9):776–784.
10.1097/MLR.0b013e3181e359df Crossref Medline, Google Scholar - 12.Nguyen-Oghalai TU, Kuo YF, Zhang DD, Graham JE, Goodwin JS, Ottenbacher KJ. Discharge setting for patients with hip fracture: trends from 2001 to 2005. J Am Geriatr Soc. 2008; 56(6):1063–1068.
10.1111/j.1532-5415.2008.01688.x Crossref Medline, Google Scholar - 13.Burgers PT, Hoogendoorn M, Van Woensel EA, Total medical costs of treating femoral neck fracture patients with hemior total hip arthroplasty: a cost analysis of a multicenter prospective study. Osteoporos Int. 2016; 27(6):1999–2008.
10.1007/s00198-016-3484-z Crossref Medline, Google Scholar - 14.Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM. Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int. 2013; 24(2):659–669.
10.1007/s00198-012-2034-6 Crossref Medline, Google Scholar - 15.Mallinson T, Deutsch A, Bateman J, Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair. Arch Phys Med Rehabil. 2014; 95(2):209–217.
10.1016/j.apmr.2013.05.031 Crossref Medline, Google Scholar
