Standardized protocol for hip fracture care leads to similar short-term outcomes despite socioeconomic differences in patient populations: a retrospective cohort study. Issue 5 (13th September 2022)

• Record Type: Journal Article
• Authors: Bindner, Corey T.; Wester, Christopher J.; Ghanta, Ramesh B.; Wininger, Austin E.; Patel, Aalok P.; Atassi, Omar H.; Perkins, Christopher H.; Dawson, John R.
• Is Part Of: Current orthopaedic practice. Volume 33:Issue 5(2022)
• Page Start: 428
• Page End: 433
• Publication Date: 2022-09-13
• Subjects: hip fracture -- orthopedics -- trauma -- osteoporosis -- healthcare disparity; Orthopedics -- Periodicals; 616.7005
• DOI: 10.1097/BCO.0000000000001148
• Languages: English
• ISSNs: 1940-7041

Abstract

Abstract : Background: Socioeconomic status is known to influence outcomes in healthcare. This study compares hip fracture care in patients of different socioeconomic status. Methods: A retrospective study of hip fracture patients over the age 65 with hip fracture who received operative care by a single surgeon was undertaken at an academic level 1 trauma center (county group, n=47) and two private tertiary care hospitals (private group, n=78). A standardized hip fracture protocol was initiated for all patients upon admission with the goal of operative management in less than 48 hr. Time-to-surgery, length of stay, and short-term postoperative complications were compared between groups. Results: Patients from the county hospital, which serves a low socioeconomic population, were largely nonwhite (93.6%) with 12.8% uninsured, whereas 32.1% of private patients were nonwhite, and all were insured. County patients had a longer time from presentation to surgery compared with private patients (30.5 hr vs 21.7 hr, respectively, P =0.003). Length of stay was equivalent between county and private patients (8.0 days vs 7.2 days, respectively, P =0.060). There was no significant difference in the rate of complications between county versus private groups (21.3% vs. 21.8%, respectively, P =0.946). Difference in 30-day mortality was not statistically significant (8.5% county vs. 3.9% private, respectively, P =0.424). No risk factors were associated with significantly increased risk of complications with logistic regression analysis. Conclusions: There was a similar length of stay, complication rate, and mortality rate after hip fracture surgery despite demographic differences between the groups. A fragility fracture protocol can lead to similar outcomes in patients of differing demographics and insurance payor mixes. Level of Evidence: Level III.