Study: Delayed Hip Fracture Surgery Raises Costs

A recent study of nearly 42,230 Canadians has found that having hip fracture patients wait more than 24 hours for surgical treatment results in higher costs and longer hospital stays.

The study, “Medical Costs of Delayed Hip Fracture Surgery,” appears in the August 15, 2018 edition of the Journal of Bone and Joint Surgery.

Co-author Daniel Pincus, M.D. is an orthopedic surgeon at the University of Toronto in Canada. “Many studies have found an association between waiting for hip fracture surgery and complications,” commented Dr. Pincus to OTW. “However, no research had previously compared medical costs of early and delayed hip fracture surgery.”

The authors wrote, “We conducted a population-based, propensity-matched cohort study of patients treated between 2009 and 2014 in Ontario, Canada. The primary exposure was early hip fracture surgery, performed within 24 hours after arrival at the emergency department. The primary outcome was direct medical costs, estimated for each patient in 2013 Canadian dollars, from the payer perspective.”

“The costs in the early and delayed groups were then compared using a difference-in-differences approach: the baseline cost in the year prior to the hip fracture that had been accrued by patients with early surgery was subtracted from the cost in the first year following the surgery (first difference), and the difference was then compared with the same difference among propensity-score-matched patients who had received delayed surgery (second difference). The secondary outcome was the postoperative length of stay (in days).”

“The study included 42,230 patients who received hip fracture surgery from a total of 522 different surgeons at 72 hospitals. The mean cost (and standard deviation) attributed to the hip fracture was $39,497 ± $46,645 per person. The matched patients who underwent surgery after 24 hours had direct 1-year medical costs that were an average of $2,638 higher and a postoperative length of stay that was an average of 0.610 day longer compared with those who underwent surgery within 24 hours.”

Dr. Pincus commented to OTW, “Costs were higher and post-operative length of stay (LOS) was longer when surgery was delayed. Results were similar irrespective of the definition of delayed surgery used (>12-, 24-, 36-, or 48-hours). Advantages of the study include a population-based approach in a single-payer system where we can follow patients closely over time to calculate costs of their medical care.”

“Waiting for hip fracture surgery is associated with increased costs and longer hospital stays, in addition to complications. Costs may provide financial incentives to mitigate delays for hip fracture surgery.”