Hip Fractures in the Elderly: the Impact of Comorbid Illnesses on Hospitalisation Costs

Introduction: Hip fractures in the elderly are associated with multiple comorbidities.

Materials And Methods: We prospectively surveyed and went through all relevant medical records of 70 consecutive patients admitted to Singapore General Hospital following either a cervical or intertrochanteric femoral fracture from late February to May 2004. The total hospitalisation cost for each patient was calculated based on the costs of inpatient care up to the point of discharge. Regression modeling was performed on the 7 commonest age-related conditions (based on our data), to determine the impact of each comorbidity on total costs.

Results: The average age of the cohort was 77.24 years. The median length of stay was 13.6 days. In patients without comorbidities, the mean hospitalisation cost was S$9,347.5 +/- 1719.6. With the presence of comorbidities, the mean cost increased to S$11,502.3 +/- 6024.3. In univariate modeling, dementia added the largest amount to total costs [S$5,398; 95% confidence interval (CI), S$1273 to S$9523; P <0.05]. The presence of diabetes (S$758; 95% CI, S$2,051 to S$3,566), hypertension (S$644; 95% CI, S$1,986 to S$3,274) and osteoarthritis (S$915; 95% CI, S$3,721 to S$1,891) did not significantly add to total costs. When controlled for multiple comorbidities, dementia retained its significance in adding to total costs (S$6,178; 95% CI, S$1,795 to S$10,562; P = 0.006).

Conclusion And Discussion: Hip fracture patients with comorbidities incurred higher hospitalisation costs. Cost-containment strategies in hip fracture patients should not only examine the number of comorbidities but also the type of disease.