We aimed to describe the characteristics and acute hospital outcomes (e.g. length of stay, ICU admission and discharge destination) of people with PD with hip fracture, and to determine the association between PD, acute hospital outcomes and 12-month mortality.
People with an isolated fractured proximal femur were identified using the Victorian Orthopaedic Trauma Outcomes Registry from 2016 to 2022. Demographic characteristics (e.g. age, sex, socio-economic status), number of comorbidities, cause and place of fracture, acute hospital length of stay, discharge destination and 12-month mortality were extracted. We identified people with PD according to ICD-10-AM codes, and inverse-probability weighting (IPW) with estimated propensity scores were used to determine the association of PD with outcomes. Propensity scores were estimated using a logistic regression model that included age, sex, number of comorbidities and socio-economic status as covariates, as well as the injury cause and location (e.g., home, residential care).
We identified 5553 patients with hip fracture; 208 in people with PD (3.7%), mean age 81.2 years (SD 7.4), including 107 (51%) males. For both cohorts, the main cause of fractures were low falls. For those with PD, the majority occurred at home or in the community (46%) or in a residential care facility (38%). After propensity score adjustment, there was no association between PD and ICU admission (OR 1.57; 95% CI 0.57, 4.30) or acute hospital length of stay (propensity-adjusted median 6.9 [IQR 4.9] vs 7.6 [5.5]; p=0.228). 12-month mortality was higher in the PD cohort but no association between PD and mortality was evident after adjusting for confounders using IPW (OR 1.19; 95% CI 0.84, 1.70). People with PD were less likely to be discharged home than to inpatient rehabilitation (RR 0.48; 95% CI 0.25, 0.89), relative to those without PD.
Compared to non-PD peers, this PD cohort had a similar length of acute hospital stay, and no increased risk of ICU admission. After accounting for age, sex and socio-economic factors including fall location, survival at 12 months was comparable. As we analysed registry data, other potential confounders such as premorbid mobility, frailty or surgery type were not considered.
The projected rise in PD prevalence will be associated with higher numbers of hip fractures. The comparable length of acute stay of the PD cohort is encouraging; avoiding prolonged hospitalisation reduces health care costs and risk of hospital-related harms. Further research is indicated to explore post acute-care discharge pathways and functional outcomes of people with PD.
Hip fracture
