Risk factors and hospital harm: a study of hip fracture patients in the community using population-based data

Background — Hip fractures are a leading cause of morbidity, mortality, and hospital-related complications among older adults. While many in-hospital complications are preventable, little is known about how individual and neighborhood-level factors contribute to preventable hospital harm in this population. This study examines associations between individual, neighborhood, and organizational-level characteristics and the likelihood of experiencing hospital harm during acute care for hip fracture among community-dwelling older adults in Ontario, Canada.

Methods — We created a retrospective cohort using linked administrative databases to capture community-dwelling individuals (50+) hospitalized with hip fracture in Ontario, Canada from April 1st, 2008 to March 31st, 2022. We measured associations between preventable hospital harm and demographic, neighborhood-level and organizational risk factors. We included hospital harm as a binary variable (overall harm/no harm) and used multivariable logistic regression, stratified by length of stay (≤ 6 versus > 6 days), to examine associations between risk factors and hospital harm.

Results — Our cohort consisted of 124,570 community-dwelling individuals with a mean age of 80.4 ± 10.6 years. 19.2% of the cohort experienced at least one incident of harm during their acute hospital stay. We observed that regardless of length of stay, individuals who were male, older, frail, had dementia, lived in urban areas or underwent surgery were significantly more likely to experience hospital harm during their hospital stay. At the neighborhood level, people who lived in areas with higher proportions of racialized and newcomer populations were more likely to experience hospital harm. When assessing organizational-level factors, we found that people visiting teaching hospitals were more likely to experience harm compared to those visiting community hospitals.

Conclusions — Our findings highlight the need for targeted safety interventions for male sex, older, frail, or marginalized populations. Future research should explore mechanisms underlying these disparities and inform strategies to prevent harm during hospitalization for hip fracture.