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Article Title

Multiple Chronic Conditions Associated With Hip Fracture Outcomes Among Males

Publication Date

8-15-2016

Keywords

hip fractures, chronic disease

Abstract

Background/Aims: Driven by an agenda to reduce hospital readmissions in integrated payer-provider systems, this study examined the association of multiple chronic conditions (MCC) with outcomes among hip fracture patients, including 30-day readmission and mortality. Models were developed in the Veterans Health Administration (VA) and will be applied to HCSRN sites in this collaboration among a Claude D. Pepper Older American Independence Center, two HCSRN sites and the VA.

Methods: The retrospective study used VA administrative data including the Corporate Data Warehouse, a snapshot of the VA’s all-electronic medical records system updated nightly. Eligibility criteria were: age > 50, male, hip fracture diagnosis (ICD-9 code 820) and inpatient hip fracture repair from October 2008 to September 2009. The primary independent variable of interest was number of chronic conditions per the Charlson and Elixhauser indices of comorbidity. Logistic regression modeled 30-day readmission, 1-year and 5-year mortality as a function of MCC, age, race/ethnicity, marriage status and VA Priority (i.e. 50–100% disabled vs. other status). Odds ratio (OR) with 95% confidence interval (CI) estimated increased risk per MCC.

Results: The sample included 3,851 veterans with mean age of 75 (SD: 11, range: 50–100); 18% were minority race/ethnicity, 23% were 50–100% disabled and 45% were married. The top five MCC were hypertension (67%), diabetes (31%), chronic obstructive pulmonary disease (29%), deficiency anemia (25%) and depression (24%). MCC per patient averaged 4.1 (SD: 2.7, range: 0–15). Adverse outcomes –– 30-day readmission (16%), 1-year mortality (31%) and 5-year mortality (65%) –– were common. MCC were associated with greater risk of 30-day readmission (OR: 1.14, 95% CI: 1.10–1.17), 1-year mortality (OR: 1.18, 95% CI: 1.14–1.21) and 5-year mortality (OR: 1.27, 95% CI: 1.23–1.31).

Conclusion: MCC greatly increased risk of adverse outcomes following hip fracture repair among men, irrespective of specific types of conditions. Each additional condition increased risk of readmission by about 14% so that risk would be doubled for a person with 7 disorders. Risk of 1-year mortality doubled at 5 MCC and of 5-year mortality at 4 MCC. Supportive services for patients and families may need to incorporate information regarding risks for patients with MCC. Next steps include assessing the role of diabetes, dementia and pharmacotherapy in the relationship between MCC and hip fracture outcomes, and replicating the study among private not-for-profit patients in HCSRN.

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