Hip fracture linked to excess hospital costs
MedWire News: Osteoporotic hip fracture is associated with pronounced excess hospital expenditure in the year following the fracture, which is mostly attributed to rehabilitation care, French research shows.
Hip fracture is known to be a large burden on hospital services, but it is unclear whether the post-fracture costs are linked to a worsening of pre-fracture comorbid conditions, say Antoine Duclos (Hospices Civils de Lyon) and colleagues.
To investigate, Duclos and team estimated the excess hospital expenditure attributable to osteoporotic hip fracture following initial hospitalization for acute care (index stay).
They identified 6019 patients aged 50 years or older who experienced hip fracture in 2005, and compared their hospitalization costs in the years before and after the index stay.
The researchers report that, 1995 (33.1%) patients had at least one stay in acute care during the year before the hip fracture, compared with 2155 (35.8%) during the year after the index stay.
Diagnoses that may increase the risk for falls such as cardiac arrhythmias, syncope, abnormalities of gait and mobility, depression, and dementia, were more frequent before the index stay.
Conversely, diagnoses potentially related to complications of hip fracture such as local complication and sequelae, decubitus ulcer, thromboembolism, urinary disorders, follow-up care and rehabilitation, and palliative care, were more common after the index stay.
Excluding the index stay, patients spent an average of 23.1 days more in hospital after their fracture compared with before the fracture. This included 22.7 days in rehabilitation care and 0.3 days in acute care.
The estimated expenditure during the year following the index stay was more than twice the expenditure during the year before hip fracture (€8394 vs €4063; US $10,672 vs US $5166). This excess expenditure was almost exclusively related to post-fracture rehabilitation care, say the researchers.
Overall, the estimated excess cost per patient was €5986 (US $7612) after the index stay, including €5673 (US $7214) spent on rehabilitation care.
"Considering that utilization of inpatient acute care was quite similar before and after the index stay, hip fracture might result from a patient's pre-fracture poor health status, rather than predispose to a worsening of such pre-existing conditions," suggest Duclos and co-authors in the journal Osteoporosis International.
"Therefore, the high-risk elderly should be identified to benefit from appropriate prevention measures and more efficient post-fracture rehabilitation care," they conclude.
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By Laura Dean