Beatrix Ling Ling Wong1, Yiong Huak Chan2, Gavin Kane O'Neill3, Diarmuid Murphy3, Reshma Aziz Merchant4,5. 1. Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. ling_ling_wong@nuhs.edu.sg. 2. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore. 3. Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. 4. Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. 5. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore.
Abstract
A hip fracture causes high morbidity and mortality. Frailty is associated with adverse outcomes and increased costs. Frailty measured using the Hospital Frailty Risk Score (HFRS) is associated with higher costs and adverse outcomes. HFRS is useful as a fuss-free frailty measurement in the management of older adults with hip fractures. INTRODUCTION: Hip fractures account for an increasing number of hospital admissions around the world and are associated with high rates of morbidity and mortality. Frailty is increasingly recognized to be associated with adverse outcomes and increased costs. The purpose of this study is to determine the association of the Hospital Frailty Risk Score (HFRS) with the healthcare cost and outcomes in older adults who present with a hip fracture. METHODS: A retrospective analysis was performed on 1014 patients ≥ 60 years who presented with a hip fracture between January 2016 to June 2020. Each patient was classified into HFRS low, intermediate or high frailty cohorts. Demographics, hip fracture type, comorbidities, Charlson Comorbidity Index (CCI), American Society of Anesthesiologist score (ASA), costs, length of stay, time to surgery, complications, readmission rate and mortality were compared between the cohorts. RESULTS: Median total hospitalization costs were significantly higher in the highest HFRS (SGD$22,432) patients as compared to intermediate (SGD$18,759) and low HFRS (SGD$15,671) patients. The difference between the high and low groups remains significant after adjusting for covariates using quantile regression. Similar results were shown for median length of stay (14 vs 10 vs 8 days), total number of complications (2 vs 1 vs 0) and adjusted time to surgery (p < 0.05). HFRS was not associated with 30-day readmission or 30-day or 1-year mortality. CONCLUSION: Frailty is associated with a marked increase in total costs in hip fracture patients. HFRS proved useful in estimating LOS and outcomes for older patients with hip fractures.
A hip fracture causes high morbidity and mortality. Frailty is associated with adverse outcomes and increased costs. Frailty measured using the Hospital Frailty Risk Score (HFRS) is associated with higher costs and adverse outcomes. HFRS is useful as a fuss-free frailty measurement in the management of older adults with hip fractures. INTRODUCTION: Hip fractures account for an increasing number of hospital admissions around the world and are associated with high rates of morbidity and mortality. Frailty is increasingly recognized to be associated with adverse outcomes and increased costs. The purpose of this study is to determine the association of the Hospital Frailty Risk Score (HFRS) with the healthcare cost and outcomes in older adults who present with a hip fracture. METHODS: A retrospective analysis was performed on 1014 patients ≥ 60 years who presented with a hip fracture between January 2016 to June 2020. Each patient was classified into HFRS low, intermediate or high frailty cohorts. Demographics, hip fracture type, comorbidities, Charlson Comorbidity Index (CCI), American Society of Anesthesiologist score (ASA), costs, length of stay, time to surgery, complications, readmission rate and mortality were compared between the cohorts. RESULTS: Median total hospitalization costs were significantly higher in the highest HFRS (SGD$22,432) patients as compared to intermediate (SGD$18,759) and low HFRS (SGD$15,671) patients. The difference between the high and low groups remains significant after adjusting for covariates using quantile regression. Similar results were shown for median length of stay (14 vs 10 vs 8 days), total number of complications (2 vs 1 vs 0) and adjusted time to surgery (p < 0.05). HFRS was not associated with 30-day readmission or 30-day or 1-year mortality. CONCLUSION: Frailty is associated with a marked increase in total costs in hip fracture patients. HFRS proved useful in estimating LOS and outcomes for older patients with hip fractures.
Authors: Ian D Cameron; Lesley D Gillespie; M Clare Robertson; Geoff R Murray; Keith D Hill; Robert G Cumming; Ngaire Kerse Journal: Cochrane Database Syst Rev Date: 2012-12-12
Authors: John E Morley; Bruno Vellas; G Abellan van Kan; Stefan D Anker; Juergen M Bauer; Roberto Bernabei; Matteo Cesari; W C Chumlea; Wolfram Doehner; Jonathan Evans; Linda P Fried; Jack M Guralnik; Paul R Katz; Theodore K Malmstrom; Roger J McCarter; Luis M Gutierrez Robledo; Ken Rockwood; Stephan von Haehling; Maurits F Vandewoude; Jeremy Walston Journal: J Am Med Dir Assoc Date: 2013-06 Impact factor: 4.669
Authors: Thomas Gilbert; Jenny Neuburger; Joshua Kraindler; Eilis Keeble; Paul Smith; Cono Ariti; Sandeepa Arora; Andrew Street; Stuart Parker; Helen C Roberts; Martin Bardsley; Simon Conroy Journal: Lancet Date: 2018-04-26 Impact factor: 79.321
Authors: Andreas Eckart; Stephanie Isabelle Hauser; Sebastian Haubitz; Tristan Struja; Alexander Kutz; Daniel Koch; Olivia Neeser; Marc A Meier; Beat Mueller; Philipp Schuetz Journal: BMJ Open Date: 2019-01-15 Impact factor: 2.692