Decision making and outcomes of a hospice patient hospitalized with a hip fracture

Abstract

Context: Hospice patients are at risk for falls and hip fracture with little clinical information to guide clinical decision making.

Objectives: To examine whether surgery is done and survival of hip fracture surgery among persons receiving hospice services.

Methods: This was an observational cohort study from 1999 to 2007 of Medicare hospice beneficiaries aged 75 years and older with incident hip fracture. We studied outcomes among hospice beneficiaries who did and did not have surgical fracture repair. Main outcomes included the trends in the proportion of those undergoing surgery, the site of death, and six-month survival.

Results: Between 1999 and 2007, approximately 1% (n=14,400) of patients aged 75 years and older admitted with a diagnosis of their first hip fracture were receiving hospice services in the 30 days before that admission and 83.4% underwent surgery. Among patients on hospice at the time of the hip fracture, 8.8% died during the initial hospitalization and an additional two-thirds died within the first six months on hospice. The median survival from hospital admission was 25.9 days for those forgoing surgery compared with 117 days for those who had surgery, adjusted for age, race, and other covariates (P<0.001).

Conclusion: Despite being on hospice services, the majority underwent surgery with improved survival. Sixty-six percent of all individuals on hospice at the time of the fracture died in the first six months, with the majority returning to hospice services.

Fig. 1

Hospice Cohort Inclusion and Exclusion Criteria DRG= Diagnosis Resource Groups.

Figure 2

Adjusted Six-Month Mortality Note: Kaplan-Meier survival curve is adjusted for: age, sex, race, location of hospice prior, ICU stay, length of hospitalization, Elixhauser comorbidity measure, fracture type, cancer, chronic obstructive pulmonary disease, dementia, cardiovascular disease, disease of the central nervous system, acute myocardial infarction, year of the fracture.