Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia.

Abstract

For older adults following a hip fracture who had hospital-acquired complications (HACs), hospital length of stay (LOS) and costs were over 40% higher compared to those without HACs. Improving strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system for an aged society. Although HACs can result in a high financial burden for health systems, little is known about the effect of common HACs on hospital LOS and cost among older adults after a hip fracture. This study examined the effect of HACs on hospital LOS and cost among older adults after a hip fracture. This retrospective cohort study used linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2022. Older adults who were admitted after a hip fracture and discharged between July 2014 and June 2022 were identified. A 1:1 matched design was used to determine hospital LOS and care costs between older patients with and without HACs. Among 41,013 older patients hospitalised after a hip fracture, 14,050 (34.3%) experienced a HAC. The most common complication was healthcare-associated infections (43.1%). After matching, patients with HACs had a longer hospital LOS (median 31 days, IQR 17-47 days) compared to patients without HACs (median 22 days, IQR 9-35 days) (P < 0.001). Patients with HACs had higher hospital costs (median $84,779, IQR $44,296-$131,426) than patients without HACs (median $60,137, IQR $23,995-$100,300) (P < 0.001). For patients with HACs, hospital LOS was 43% longer (95% confidence interval (CI): 1.41-1.46), and hospital costs were 42% higher (95% CI: 0.40-0.44) compared to those without HACs. Implementing strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system as HACs are potentially preventable.