Abstract and Introduction
Abstract
Background: We sought to examine the preoperative time for hip stabilization procedure among Hispanics, non-Hispanic blacks (blacks) and non-Hispanic whites (whites).
Methods: This was a secondary data analysis using Medicare claims data. Our analysis included 40,321 patients admitted for hip fracture hospitalization from 2001–2005. Our primary analysis was generalized linear modeling, and our dependent variable was preoperative time. Our independent variable was race/ethnicity (Hispanics, blacks versus whites), and covariates were age, gender, income, type of hip fracture and comorbidities.
Results: Bivariate analyses showed that both Hispanics and blacks experienced a longer preoperative time (P < 0.01). The average (mean) of days to surgery was 1.2 for whites, 1.6 for blacks and 1.7 for Hispanics. The delayed preoperative time among Hispanics and blacks persisted after adjusting for covariates.
Conclusions: The delayed preoperative time among minorities suggests the need to closely monitor care among minorities with hip fracture to determine how to best address their developing needs.
Introduction
More than 300,000 patients fracture their hips every year. The majority of hip fractures occur in older patients, and 75% of hip fractures occur in women. Hip fracture refers to fracture of the proximal femur and is classified anatomically. The majority of hip fractures (90%) are intertrochanteric (pertrochanteric) and femoral neck fractures (transcervical fracture), while between 5 and 10% of hip fractures are subtrochanteric fractures. The site of fracture affects prognosis and the choice of stabilizing procedures.
Hip fracture is associated with high mortality and morbidity. A significant number of hip fracture morbidity is associated with the inability to walk, the typical symptom of hip fracture. Mobility can be restored after surgical stabilization. Exceptions to surgical stabilization are made for nonambulatory nursing home residents or for patients with too many comorbidities to undergo surgery. Until the time of stabilization surgery, patients are immobilized and are at risk for related morbidity. Short- and long-term complications of immobility include deep vein thrombosis with or without pulmonary emboli and decubitus ulcers. Complications and/or poor recovery can lead to long-term loss of mobility and independence resulting in nursing home placement.
Management of hip fracture requires timely surgical stabilization to reduce postoperative morbidity. In the majority of cases, delay of stabilization surgery after hip fracture is due to the delay of medical evaluations and/or the stabilization of such medical problems as chest pain and hypertension. The known higher prevalence of undiagnosed diabetes and uncontrolled hypertension among Hispanics and blacks versus whites suggests that minorities may experience delayed surgical stabilization after hip fracture.
Findings of delayed surgical stabilization among minorities could help identify at-risk patients and facilitate future interventions. The purpose of this study was to compare preoperative time among Hispanics and blacks versus whites, using secondary data analysis of a 5% random sample of the Medicare claims data from 2001 to 2005.