Outcomes Following Geriatric Hip Fracture Surgery in Diabetic Patients: A Nationwide Population-based Matched Cohort Study
Yuan-Pei Lin, Su-Ju Lin, Tien-Hsing Chen, Liang-Tseng Kuo, Wei-Hsiu HsuAbstract
Background:
Hip fracture is a common disease for older people, and operative management provides more benefits than conservative treatment. However, the optimal surgical options for geriatric patients with hip fractures remain debated.
Objectives:
To compare the clinical outcomes of hemiarthroplasty versus internal fixation in diabetic patients with a fragility hip fracture.
Materials and Methods:
This retrospective cohort study utilized data from the Taiwan National Health Research Insurance Database. Patients with type 2 diabetes who underwent hemiarthroplasty or internal fixation for a first-ever fragility hip fracture between 2000 and 2013 were enrolled. The primary outcome was the incidence of major surgical complications within 1 year after surgery. Secondary outcomes included in-hospital complications, length of stay, medical costs, readmission, and mortality.
Results:
After propensity score-matching, there were 26,499 patients in each group (hemiarthroplasty vs. internal fixation). Hemiarthroplasty was associated with higher rates of in-hospital complications, including delirium, urinary tract infection, pneumonia, and surgical site infections, but showed a lower risk of transfusion. After index hospitalization, hemiarthroplasty patients had an increased risk of deep infections (subdistribution hazard ratio [SHR] = 1.35 and 95% confidence interval [CI]: 1.15–1.60), but lower risks of revision surgery (SHR = 0.43 and 95% CI: 0.38–0.49) and overall surgical complications (SHR = 0.74 and 95% CI 0.67–0.81). Internal fixation patients demonstrated higher readmission risk at 3 months and 1-year follow-up. However, the mortality risk was comparable between these two groups.
Conclusions:
While hemiarthroplasty was associated with higher in-hospital complications, it offered advantages over internal fixation in reducing reoperation and readmission rates postdischarge, making it a viable option for diabetic patients with hip fractures.