Health outcomes of older adults in long-term care homes following hospitalization for hip fracture surgery: a retrospective observational cohort study in Ontario, Canada

Introduction — Hip fractures are debilitating for older adults, particularly those living in long-term care (LTC) homes. While surgical repair can alleviate pain and restore function, it carries the risk of several complications, including delirium, infection and cardiovascular events. Our objectives were to compare outcomes in LTC residents who did and did not undergo surgery following hospitalization for a hip fracture and assess the utility of existing frailty indices in differentiating outcomes in this population.

Methods — We used a retrospective observational cohort of older adults from LTC homes in Ontario, Canada, hospitalized for hip fractures between January 1, 2015, and December 31, 2019. Primary exposure was surgery. Outcomes included in-hospital and 30-day post-discharge mortality, pain and functional mobility at 180 days post-discharge. Analyses were stratified by frailty level using four different indices. Logistic regression models were estimated to assess the associations between surgery, frailty, and outcomes.

Results — Among 5,279 older adults meeting inclusion criteria (mean age = 87.0 years, 74.2% female), 86.1% received surgical repair. Following adjustment across multiple models, surgery was significantly associated with reduced in-hospital (adjusted odds ratio [aOR] = 0.27-0.29) and 30-day (aOR = 0.65-0.66) mortality. While the surgical group was less likely to experience pain (aOR = 0.88-0.91) and had higher odds of preserved or improved functional mobility (aOR = 1.35-1.37) at 180 days, these differences were not statistically significant. Likewise, while the frailty indices were predictive of mortality, they were not significantly associated with the odds of experiencing pain or functional mobility at 6 months. Among those who underwent surgery, RESPECT and CHESS were strongly associated with in-hospital and 30-day mortality, suggesting utility for perioperative risk stratification.

Conclusions — In LTC residents with hip fractures who are eligible and fit for surgery, surgical management was associated with improved survival, which can be predicted using existing frailty indices.