The association between hospital harms and 1-year mortality following a hip fracture in Ontario, Canada: a cohort study

Background — Hip fractures are a significant public health concern, associated with substantial morbidity and mortality. Mortality is the most serious consequence of hip fractures, with a 1-year rate ranging from 14% to 36%. Hospital harms are also more prevalent among older adults with hip fractures, further increasing their risk of mortality. This study aimed to assess the incremental risk of all-cause mortality up to one-year post-discharge among hip fracture patients who experienced hospital harm.

Methods — A population-based retrospective cohort study using linked health administrative data in Ontario, Canada, was conducted. The cohort included individuals aged 50 years and older hospitalized for hip fractures between April 2008 and March 2022 and discharged alive. All-cause mortality within one-year post-discharge was the primary outcome, and hospital harm was the main exposure. We used Cox proportional hazards models to assess the association between hospital harm and mortality, adjusting for covariates (e.g., age, sex, comorbidities, frailty, and surgery status).

Results — A total of 131,472 patients admitted for acute hip fractures and discharged alive were included in the study, with a mean age of 80.67 ± 10.56 years. Of these patients, 17.5% experienced hospital harm during their admission for an acute hip fracture. The overall mortality rate was 18.4% within 1-year post-discharge. After adjusting for covariates, patients who experienced overall harm had a 42% higher risk of all-cause mortality during the 1-year period post-discharge (adjusted hazard ratio, aHR = 1.42, 95% confidence interval, CI: 1.38–1.46) compared to those without harm.

Conclusion — Experiencing hospital harm significantly increased the risk of 1-year mortality after discharge among hip fracture patients. These findings underscore the importance of improving patient safety and minimizing preventable harm in hospital settings. Mitigation strategies, such as enhanced monitoring and safety protocols, could reduce hospital harm and improve long-term survival. Future research should focus on evaluating such interventions.