Transfer status in geriatric hip fracture surgery - An independent risk factor associated with 30-day mortality, re-operations and complications.

BACKGROUND

A significant proportion of patients undergoing hip fracture surgery are transferred from other locations. With no current orthopedic literature present, we sought to study the impact of transfer location on 30-day outcomes following geriatric hip fracture surgery.

MATERIALS & METHODS: The 2015-2016 ACS-NSQIP database was queried using CPT codes to retrieve records of geriatric patients undergoing hip fracture surgery (total hip arthroplasty/THA, hemiarthroplasty/HA and open reduction internal fixation/ORIF). Transfer status was defined into four groups - 1) No transfer (admitted from home), 2) From acute care hospital, 3) From nursing home/chronic care facility and 4) From outside emergency department (ED). Patients with missing data were excluded. A total of 31,218 patients were included in the final cohort.

RESULTS

Out of 31,218 patients - 23,659 (75.8%) were admitted from home, 1574 (5.0%) from acute care hospitals, 3299 (10.6%) from nursing home/chronic care facilities and 2686 (8.6%) from outside EDs. Following adjusted analysis, transfer from nursing home vs. home was associated with higher odds of 30-day mortality (OR 1.57 [95% 1.36-1.80]; p < 0.001), 30-day re-operations (OR 1.36 [95% CI 1.10-1.68]; p = 0.005), septic shock (OR 1.58 [95% CI 1.07-2.32]; p = 0.021), sepsis (OR 1.45 [95% CI 1.05-1.99]; p = 0.023) and urinary tract infection (OR 1.21 [95% CI 1.02-1.42]; p = 0.025). Additionally, transfer from outside ED vs. home was also associated with higher odds of 30-day mortality (OR 1.26 [95% CI 1.06-1.50]; p = 0.010).Transfer from any location (acute care hospital, nursing home and outside ED) was significantly associated with higher odds of non-home discharge (p < 0.001).

CONCLUSION

Transfer status is an important risk factor associated with 30-day mortality and morbidity in geriatric patients undergoing hip fracture surgery. The findings stress the need for recognition of these patients as being a high-risk group to allow enhanced medical optimization in an attempt to minimize the risk of poor outcomes.