Clinical question: Does surgical repair of hip fractures in nursing home residents with advanced dementia reduce adverse outcomes?
Background: Hip fractures are common in the advanced dementia nursing home population. The benefit of surgical repair is unclear in this population given significant baseline functional disability and limited life expectancy.
Study design: Retrospective cohort study.
Setting: Medicare claims data set.
Dr. Alexander Abramowicz
Synopsis: Among 3,083 nursing home residents with advanced dementia and hip fracture, nearly 85% underwent surgical repair. The 30-day mortality rate in the nonsurgical group was 30.6%, compared with 11.5% in the surgical group. In an adjusted model, the surgical group had decreased risk of death, compared with the nonsurgical group (hazard ratio, 0.88; 95% confidence interval, 0.79-0.98). In additional adjusted models, surgical patients also had decreased risk of pressure ulcers (HR 0.64; 95% CI, 0.47-0.86) and less pain (HR, 0.78; 95% CI, 0.61-0.99). Limitations included the observational nature of the study. Although the models were adjusted, unmeasured confounding may have contributed to the findings.
Bottom line: Surgical repair of hip fractures in nursing home patients with advanced dementia reduces post-fracture mortality, pain, and pressure ulcer risk.
Citation: Berry SD et al. Association of clinical outcomes with surgical repair of hip fracture vs. nonsurgical management in nursing home residents with advanced dementia. JAMA Intern Med. 2018;178(6):774-80.
Dr. Abramowicz is an assistant professor in the division of hospital medicine, University of Colorado, Denver.
