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Isolated Hip Fractures in the Elderly: Best Practice Analysis of Perioperative Medical Optimization Including Effect
Heather Rhodes1, Evelyn Coile2, Tatiana Eversley-Kelso2
123765Grand Strand Regional Medical Center, Myrtle Beach, SC, USA.
Insights
Elderly patients with isolated hip fractures (IHFs) experienced longer hospital stays if they had prior functional decline. Comorbidities did not significantly impact outcomes like ICU admission or length of stay.
Area of Science:
- Geriatric Medicine
- Trauma Surgery
- Public Health
Background:
- Isolated hip fractures (IHFs) are a significant cause of functional decline in older adults.
- Effective management of IHFs is crucial for maintaining quality of life in the elderly population.
Purpose of the Study:
- To evaluate outcomes of isolated hip fractures (IHFs) at two Level 1 trauma centers.
- To determine the impact of comorbidities on length of stay (LOS), ICU admission, disposition, and mortality in elderly IHF patients.
Main Methods:
- Retrospective study of 785 patients aged 65 and older with IHFs from July 2016 to December 2020.
- Analysis of factors including prior functional status, comorbidities, advanced directives, and specific conditions like cirrhosis/substance abuse.
- Evaluation of length of stay, ICU admission rates, patient disposition (home, rehabilitation, SNF), and mortality.
Main Results:
- Prior dependent functional status was associated with a longer LOS (>6 days, P = .01).
- Comorbidities did not significantly increase LOS or ICU admission.
- ICU admission rate was 12.75%; higher in patients with advanced directives (8% vs 3%).
- Overall mortality was 2%, but increased with advanced directives (17% vs 2%, P < .05) and cirrhosis/substance abuse (12% vs 2%, P < .05).
- Disposition varied: 20% home, 43% rehabilitation, 31% skilled nursing facility (SNF).
Conclusions:
- While comorbidities did not broadly affect ICU admission, LOS, or disposition, specific conditions like cirrhosis/substance abuse were linked to increased mortality.
- Advanced directives were associated with higher ICU admission and mortality rates.
- Functional status prior to fracture is a key predictor of longer hospital stays in elderly IHF patients.
Abstract:
Isolated hip fractures (IHFs) contribute to functional decline in the elderly. Our purpose was to evaluate IHF at two level 1 trauma centers and the effect of comorbidities on length of stay (LOS), ICU admission, disposition, and mortality. A retrospective study from July 2016 through December 2020 including patients ≥65 with IHFs identified 785 patients. Prior dependent functional status yielded a longer LOS (>6 days vs <6 days, P = .01). Comorbidities were not associated with increased LOS or ICU admission. ICU admission rate was 12.75%. Patients with advanced directive had increased ICU admission (8% vs 3%). The mortality rate was 2%. Increased mortality was seen with advanced directives (17% vs 2%, P < .05) and cirrhosis/substance abuse (12% vs 2%, P < .05). Disposition included home (20%), rehabilitation (43%), and SNF (31%). Comorbidities did not affect ICU admission, LOS, or disposition; however, cirrhosis/substance abuse demonstrated increased mortality.
