The economic impact of medical complications in geriatric patients with hip fracture.

Khasraghi, F. A., Lee, E. J., Christmas, C., & Wenz, J. F. (2003). Orthopedics, 26(1), 49-56.

This retrospective study of 510 records determined the incidence and type of medical complications that occurred in elderly patients with a hip fracture in the study hospital between January 1995 and December 2000. The economic effect of those complications was then estimated based on the length of hospitalization and treatment cost. Of the 510 patients, 217 (43%) developed at least one medical complication. The most frequent complications were electrolyte imbalance (11%), urinary tract infection (10%), respiratory failure (10%), and delirium (9%). The patient's age, sex, fracture site, and fracture type were not significant in predicting the development of complications

Complications often resulted in a prolonged hospital stay. Patients with one medical complication had a mean hospital stay of 10 days and a mean hospital cost of $16,204. Patients without complications had a mean hospital stay of 5 days and cost of $10,289. The difference in cost was $5,919, or 58%, higher to treat patients who had a medical complication. Throughout the years, there has been an increase in the financial impact of hip fracture treatment. In 1984, the cost of a hip fracture treatment in the United States was estimated at $7.2 billion. By 2040, the cost of hip fracture treatment is expected to range from $82 to $240 billion. Charges incurred in the hospital are the largest single cost element of medical care for these patients. Hospitalization alone accounts for up to 44% of direct medical costs after a hip fracture, and one major factor is the length of hospital stay.

Reducing or preventing complications after a hip fracture must begin with a preoperative risk assessment of the patient to focus perioperative and postoperative care management. Keeping the patient well hydrated and free of pain; having him or her turn, cough, and deep breathe; and encouraging early mobilization are only the basics. Electrolyte imbalance was the most common complication. Zuckerman et al. (1992) suggested that diuretics may be the main cause of this imbalance. Although it may not present a problem in and of itself, electrolyte imbalance has the potential to produce subsequent medical complications, such as delirium and cardiac arrhythmias. Being alert for and assessing for early signs of electrolyte imbalance is needed.

Urinary tract infection may be reduced by removing indwelling urinary catheters within 24 hours postoperatively and then either managing with a voiding schedule or using intermittent straight catheterization, as necessary. Some institutions choose to use scheduled intermittent straight catheterization after the indwelling catheter is removed.

Preventing postoperative respiratory complications in this age group depends on the patient's preoperative lung condition. The most common respiratory complication after hip fracture is respiratory failure. This may result from chronic obstructive pulmonary disease, but other contributing factors include aspiration during intubation, heart failure, and malnutrition.

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