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. 2024 Nov 27;16(11):e74586.
doi: 10.7759/cureus.74586. eCollection 2024 Nov.

Outcome and Cost Evaluation of Hip Fractures in Elderly Patients at a Tertiary Care Hospital in the Caribbean

Camille Sanderson-Jerome  1 , Seetharaman Hariharan  2
Affiliations

Outcome and Cost Evaluation of Hip Fractures in Elderly Patients at a Tertiary Care Hospital in the Caribbean

Camille Sanderson-Jerome et al. Cureus. .

Abstract

Introduction Hip fractures in the elderly are considered one of the most common types of orthopedic injuries, associated with increased morbidity and mortality. The incidence has been increasing over the years, and its management has also caused a significant economic burden for most countries worldwide. This study aimed to determine the outcomes and economic costs associated with hip fractures in elderly patients at a tertiary care institution in Trinidad and Tobago. Methods A chart review of patients aged > 65 years admitted with a diagnosis of hip fractures for one calendar year was conducted, followed by a prospective survey to determine their current status. Demographics and clinical data were collected. Outcomes measured included the time to surgery (lead time), complications by Clavien-Dindo score, hospital length of stay and mortality, and costs of hospitalization. Results Thirty patients who fulfilled the criteria for chart review and follow-up were studied. The age of patients ranged from 65 to 117 years with a mean of 82.0 ± 10.58 (standard deviation (SD)). The mean lead time from admission to surgery was 17.2 ± 14.2 (SD) days. The mean hospital length of stay was 24.4 ± 15.6 (SD) days. The mean cost of hospitalization was found to be US $10,256 per patient. Postoperative complications were seen in 57% of patients and non-surgical complications were more frequent than surgical complications. The longer the lead time to surgery, the longer the hospital length of stay (p<0.0001); the longer the length of stay, the higher the costs (p<0.0001). The hospital mortality was 27% and one-year mortality was 50%; the lead time to surgery did not impact hospital mortality. Conclusion Prolonged lead time until surgery for elderly hip fracture patients increased their hospital length of stay and significantly increased the costs of their management, adversely affecting their outcomes, which needs to be addressed at the administrative level.

Keywords: elderly hip fractures; healthcare outcomes; surgical costs; surgical hip repair; the caribbean region.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The North West Regional Health Authority Ethics Committee issued approval None. On 18th November 2019, the Secretary of the North West Regional Health Authority Ethics Committee sent a formal letter of approval for conducting the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Timing of operation
Figure 2
Figure 2. Reasons for surgical delay
OR = Operating Room
Figure 3
Figure 3. Postoperative complications
UGIB = Upper gastrointestinal bleed; UTI = Urinary Tract Infection; AKI = Acute Kidney Injury; LRTI = Lower Respiratory Tract Infection
Figure 4
Figure 4. Length of stay and costs
Figure 5
Figure 5. Surgical procedure, duration and costs
IM = intramedullary
Figure 6
Figure 6. Receiver operating characteristic (ROC) curves for age and the number of comorbidities
numbercomorb = number of comorbidities
See this image and copyright information in PMC

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