The Impact of Comorbidity on Perioperative Outcomes of Hip Fractures in a Geriatric Fracture Model

Abstract

Background: Older adults who sustain hip fractures usually have multiple coexisting medical problems that may impact their treatment and outcomes. The geriatric fracture center (GFC) provides a model of care that standardizes treatment and optimizes outcomes. The purpose of this study is to determine whether GFC patients with a higher burden of comorbidity or specific comorbidities are at risk for worsened perioperative outcomes, such as increased time to surgery (TTS), postoperative complications, and longer length of hospital stay (LOS). Method: A total of 1077 patients aged 60 years and older who underwent surgery for a proximal femur fracture between April 15, 2005, and September 30, 2010, were evaluated. Comorbidities measured in the Charlson Comorbidity index were abstracted through chart review. Outcomes were TTS, postoperative complications, and LOS. Results: Most patients were white, with an average age of 85. One half lived in either a nursing home or an assisted living facility. The mean Charlson score was 3.06 and the nursing home residents had a significantly higher score compared to community dwellers (3.4 vs 2.8; P < .0001). Dementia was the most common comorbidity. There was no difference in the LOS or TTS based on Charlson score. The overall complication rate was 44% with delirium being the most common postoperative complication. Peripheral vascular disease, history of solid tumor, and peptic ulcer disease predicted delirium incidence. Charlson score predicted complication risk, with an odds ratio of 1.12 for each point increase. Conclusion: Frailty and comorbidity put this hip fracture population at high risk for adverse perioperative outcomes. This study shows that in the GFC model of care the comorbidity burden did not impact the TTS and LOS but did predict postoperative complication rate.

Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

“…The predominantly female cohort included in this series is typical for a geriatric patient population with a comparatively high ASA score at hospital admission [35,36,37]. In accordance with the current literature, in the present study cognitively impaired patients (group II) were admitted to hospital significantly more often from nursing homes [38] and showed reduced BI values [39].…”

Surgical Time of Day Does Not Affect Outcome Following Hip Fracture Fixation

“…24 Sex, race, and impaired renal or cardiac disease have also been shown to predispose to poorer outcomes and increased mortality. [25][26][27] Many authors have therefore focused on factors that may decrease complications and improve mortality following hip fracture surgery. [15][16][17][18][19] Time to surgery, in particular, has attracted considerable attention.…”

“…[6][7][8][9][10][11][12][13][14][15] Poor outcomes may be predicted by patient comorbidities, surgical timing, and surgical volume. 7,[15][16][17][18][19][20][21][22][23][24][25][26][27] The effect of surgical time of day on hip fracture outcome is less clear.…”

Health Economic Implications of Perioperative Delirium in Older Patients After Surgery for a Fragility Hip Fracture

“…On the basis of the work by Austin et al 18 , we included all propensity-matching variables that were not influenced by the presence of the exposure and that could influence either the exposure and outcome or the outcome alone. To produce propensity scores for each episode of care, we constructed a binary logistic regression model with perioperative delirium as the dependent variable and age, sex, number of comorbidities, American Society of Anesthesiologists (ASA) class, and living in a nursing home or other skilled-care facility prior to admission as the independent variables because those variables have been previously reported to predict either exposure and outcome or outcome alone 5,[19][20][21][22] . Additionally, the year of hospital admission was included as an indicator variable.…”