The impact of delayed management of fall-related hip fracture management on health outcomes for African American older adults

Abstract

BACKGROUND: Black hip fracture patients experience worse health outcomes than otherwise similarWhite patients, but causes of these disparities are not known.We sought to determine if delays in hip fracture surgery and/or hospital structures contribute to racial disparities in hip fracture outcomes. METHODS: Using 2006 to 2016 Trauma Quality ProgramPublic Use Files, we identified hip fracture patients with primarymechanisms of fall from standing and determined surgical treatment category (no surgery, surgery within 24 hours after arrival, surgery 24-48 hours after arrival, surgery more than 48 hours after arrival) as well as hospital structure characteristics (trauma center designation, teaching status, profit status, bed size).We used generalized structural equation models to conduct path analyses and determine if hip fracture treatment and hospital characteristicsmediated the relationship between race (non-Hispanic Black/non-HispanicWhite) and outcomes (complications, length of stay, disposition). RESULTS: Non-Hispanic Black patientsweremore likely than non-HispanicWhite patients to receive treatment at an academic medical center (49.1%vs. 28.0%), at a hospitalwith >600 inpatient beds (39.5%vs. 25.3%), and at a level I or II trauma center (86.8%vs. 77.7%); were more likely to go without hip fracture repair surgery (22.8% vs. 21.4%); and were more likely to have delayed surgery >48 hours after hospital arrival (15.5% vs. 10.6%). Path analysis suggests hip fracture treatment group and hospital characteristics mediate the relationship with complications, length of stay, and disposition. CONCLUSION: Non-Hispanic Black patientswith fall-related hip fracture are more likely to experience delays in care, complications, and longer inpatient stays. Hospital characteristics contribute to increased risk of complications and longer length of stay, both as independent determinants of outcomes and as determinants of delays in hip fracture surgery.