Hospital Transfers for Hip Fracture Patients Are Associated With Higher Cost and Mortality

Transferring hip fracture patients may increase morbidity and cost. The purpose of this study was to examine time to surgery, outcomes, and cost in patients undergoing operative management of displaced femoral neck fractures (DFNFs), comparing those admitted through the emergency department (ED) and those transferred from outside hospitals.

A retrospective review of surgically managed DFNF patients (age ≥ 65 years) at a single institution between May 29, 2020, and December 29, 2022, was performed. Patients were categorized into two groups: "ED arrivals" and "transfers." Demographics, time from presentation to surgery, hospital length of stay, discharge disposition, 1-year readmission, reoperation, and mortality, and total cost of care were collected and compared. We identified 459 patients (ED = 422, 92.0%, Transfer = 37, 8.0%). There was no difference in age, sex, body mass index, or American Society of Anesthesiologists status.

Median time from ED to operating room was higher in the transfer group (41.6 versus 23.2 hours, P < 0.0001). Transfer and ED patients had similar length of stay (5.9 versus 6.0 days, P = 0.29) and similar rates of discharge to skilled nursing facility (66.1 versus 62.2%, P = 0.39). There was a higher rate of 1-year mortality (27.0 versus 13.5% for ED, P = 0.03) in transfer patients but no difference in 1-year readmission or reoperation. Adjusting for demographics, transfer patients had 2.6 higher odds of 1-year mortality than ED patients (odds ratio = 2.59 (1.13 to 5.94) P = 0.03). The cost of care was higher for transfer patients ($23,521 versus $13,980, P < 0.0001).

Transferring DFNF patients was associated with delayed time to surgery, increased 1-year mortality, and higher costs. Transferring patients is a logistical reality for many conditions; however, efforts should be made to provide efficient, safe, and cost-effective care.