Coexisting medical conditions increase treatment costs and lengthen hospitalization after hip fractures

Kevin P. Black

Independent existing medical conditions significantly increase the treatment costs and length of hospitalization for older patients who have sustained hip fractures, according to a recently published study.

The findings were reported in the Journal of Bone and Joint Surgery.

“Current reimbursement to hospitals only considers if a patient is categorized as having a major comorbidity, a comorbidity, or no comorbidity,” study author Kevin P. Black, MD, stated in an American Academy of Orthopaedic Surgeons news release. “Our study demonstrates that specific comorbidities significantly increase costs and length of stay associated with the treatment of hip fractures.”

For the study, researchers gathered hospital discharge information from a 2007 Agency for Healthcare Research and Quality report that included data from 1,044 hospitals across 40 states. The study involved 32,440 patients and included information on race, sex, hospitalization cost, length of stay, age, type of hip fracture sustained and type of surgical hip fracture treatment. Around 80% of patients in the study were 75 years of age or older, 72.3% were female and 87.9% were Caucasian.

According to the study findings, patients were found to commonly have two or three comorbidities, with 4.9% of patients demonstrating no comorbidities. The most common comorbidity was high blood pressure, which impacted 67% of patients. Other comorbidities included deficiency anemias, fluid and electrolyte disorders, chronic lung disease, uncomplicated diabetes and neurological disorders.

Using an average estimated cost in a reference patient of $13,805, the researchers found patients with hip fracture who were very thin or malnourished displayed the greatest increased costs, followed by patients with pulmonary circulatory disorders. Length of stay was most impacted by recent weight loss or malnutrition, as these factors increased hospital stay by 2.5 days. Congestive heart failure increased hospital stay by 1.1 days with pulmonary circulation disorders increasing stay by 0.9 days.

“We need to better understand the total cost of caring for hip fracture patients,” Black stated in the release. “Our study focused only on acute hospitalization … second, this study did not investigate the quality or outcomes of care.”

“Having a better understanding of the comorbidities that affect hip fracture patients hopefully will lead to the development of strategies to more effectively care for these patients,” he added.

Reference:

Nikkel LE, Fox EJ, Black KP, et al. Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am. 2011. doi: 10.2106/JBJS.J.01077.

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