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

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.