Standardized protocol for hip fracture care leads to similar short-term outcomes despite socioeconomic differences in patient populations: a retrospective cohort study

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.