Hospital costs attributable to further fracture, reoperation, and death during the first year following hip fracture in England : a nationwide cohort study

Within one year after hip fracture in older adults living in England, this study aimed to estimate the inpatient hospital costs associated with subsequent complications, including further fractures, reoperations, and death. The study linked national datasets to identify all patients aged ≥ 60 years who underwent an index hip fracture operation in all hospitals in England between 1 April 2016 and 31 March 2019, with one-year follow-up. Patients were categorized into eight mutually exclusive groups based on combinations of further fracture (after 30 days from index hip fracture, at any skeletal site, excluding facial, digit, and skull fractures), reoperation, and death in the year after hip fracture. Inpatient costs were valued using 2019/20 NHS reference costs. Marginal cost differences over patients with no complications were estimated using generalized linear models. Among 164,691 patients (70.8% female (n = 116,534); mean age 82.7 years (SD 8.7)), across 159 hospitals, the mean one-year inpatient cost was £14,581 (SD 8,583). Further fracture (£24,306 (SD 11,635); n = 11,226) and reoperation (£23,923 (SD 13,537); n = 7,522) were each associated with approximately twice the cost of patients without complications (£12,859 (SD 7,097); n = 107,638). Additional costs, adjusted for prefracture costs, fracture type, and patient case-mix variables, were highest for patients with further fracture and reoperation who died within one year (+£16,971 (95% CI 15,914 to 18,028); n = 541), closely followed by patients with both further fracture and reoperation who survived (+£13,562 (95% CI 13,065 to 14,059); n = 2,348), compared with adjusted cost of patients who survived with no complications (mean £13,159 (95% CI 13,118 to 13,201)). Nationally, annual inpatient expenditure for hip fracture care was estimated to £647 million in 2018/19. Of this, £265 million was attributable to patients with a complication (35% of all patients). Nearly half of total national inpatient expenditure on hip fracture care is concentrated among patients who experienced complications or died. Further fracture and reoperation markedly increase inpatient expenditure, highlighting the importance of preventing complications and refractures.