Relationship between comorbidities and treatment decision-making in elderly hip fracture patients

Background Elderly patients are at a higher risk for hip fracture. Moreover, hospitalized elderly patients with hip fracture are vulnerable to adverse outcomes including higher mortality rate and long-term disability. Treatment decision-making with respect to surgical procedure and perioperative management of these patients is typically challenging owing to the presence of multiple comorbid conditions. Aims The purpose of this study was to investigate the relationship between comorbidities in elderly patients with hip fracture and the treatment decision-making. Methods 884 geriatric patients (age ≥ 60 years) with hip fracture were included. Comorbidities related to age were measured using the Charlson Co-morbidity Index (CCI) and age-adjusted CCI. The CCI of each geriatric hip fracture patient was calculated based on data retrieved from the medical records. The relationship of CCI and age-adjusted CCI with surgical procedure, time-to-surgery, length of hospital stay, and perioperative management (transfusion, anti-coagulation, and analgesia) was assessed. Results Mean age of patients was 78.01 ± 8.62 years. The mean CCI was 0.79 ± 0.036; the mean age-adjusted CCI was 4.15 ± 0.047. The CCI was significantly associated with time-to-surgery ( P = 0.004), surgical treatment ( P < 0.001), and transfusion ( P = 0.023). The age-adjusted CCI was significantly associated with surgical treatment ( P < 0.001), analgesia ( P = 0.003) and transfusion ( P < 0.001). The length of hospital stay was associated with both CCI ( P = 0.041), age-adjusted CCI ( P = 0.002), and hypertension ( P = 0.012). Hospital expenses showed a significant association with CCI ( P = 0.000), age-adjusted CCI ( P = 0.029), osteoprosis ( P = 0.007), and hypertension ( P = 0.001). Conclusion In this study, comorbidities were positively associated with surgical procedure and perioperative management of elderly patients with hip fracture.