The terrible 2s: twice the risk of inpatient complications in 2nd geriatric hip fractures

Abstract

Purpose:

To characterise differences in baseline demographics, outcomes, and cost between 1st and 2nd (contralateral) hip fracture hospitalisations in the same patient that occur within 5 years of each other.

Methods:

A retrospective review of operatively treated hip fractures was performed at an academic medical centre. Inclusion criteria: age ⩾65 years, presence of a first and second, contralateral hip fracture with OTA 31A/B classification within 5 years of the hip fracture. Analysis was based on the chronological order of their fracture – 1st hip fracture versus 2nd hip fracture. Comparison of patients’ demographics, postoperative complications, 90-day readmission rates, 1-year mortality, discharge location, and direct inpatient hospitalisation costs were compared. Major complications were defined as: sepsis, acute respiratory failure, myocardial infarction, stroke, pulmonary embolus, or death.

Results:

A total of 78 patients’ 1st hip fracture hospitalisation was compared to their 2nd hip fracture hospitalisation. Mean time to 2nd hip fracture was 589.9 ± 508.4 days and mean age was 84.2 ± 8.2 years. More second hip fracture patients were household ambulators (47% vs. 26%, p = 0.012) and assistive device users (87% vs. 50%, p = 0.001). Second hip fracture patient also trended towards being sicker (CCI 2.1 ± 1.9 vs. 1.6 ± 1.6, p = 0.062; STTGMA: 2.4% ± 5.9% vs. 1.2% ± 0.2.0%, p = 0.081). The 2nd hip fracture cohort also trended to having more major complications (21% vs. 10%, p = 0.05) and more minor complications (58% vs. 44%, p = 0.08). There were no other differences in outcomes and hospitalisation cost.

Conclusions:

Patients who sustain a 2nd contralateral hip fracture within 5 years of their first hip fracture demonstrate a trend towards having more major and minor inpatient complications There are otherwise comparable hospital quality measures and cost profile during their 2nd hip fracture hospitalisation compared to their 1st hip fracture hospitalisation. Resources should be allocated to minimise the risk of complications in 2nd hip fracture patients.