Medical and economic consequences of perioperative complications in older hip fracture patients

Abstract

Summary Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. Purpose Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. Methods A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. Results Complications that required surgical revision/treatment (type III) were associated with an increased 6 months’ mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. Conclusions The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.

Hip fracture treatment and complications after surgery

“…The article also mentions the economic impact, mentioning that patients with conditions requiring surgical revision and treatment such as hematoma, pleural effusion, and wound infection are associated with higher costs. 8 Talking about the complications associated the most effective tool that clinicians have to predict is the ASA score before and after the treatment. We found a retrospective cohort study made in Sweden based on data from 1987 to 2017 from the Swedish National Inpatient Register, which included 170,193 patients with first hip fractures.…”

Data-driven development of the nationwide hip fracture registry in the Netherlands

“…Consequently, in-hospital complications have severe consequences for hip fracture patients. They are related to decreased functional outcomes and quality of life, higher mortality rates, and increased health care costs [26,27]. However, studies on preventing complications in hip fracture patients usually do not examine organizational factors other than the involvement of a geriatrician [28,29].…”

The Financial Burden of Delayed Hip Fracture Surgery: A Single-Center Experience

“…Adverse events such as myocardial infarction, stroke, and acute renal failure requiring dialysis were the most costly, followed closely by complications that necessitated surgical revision. The latter also had the highest one-year mortality rate among the other types of major complications [ 17 ].…”