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Background: Geriatric hip fractures are common and important sentinel events regarding bone health. Although dual x-ray absorptiometry (DEXA) scans are a standard method for determining bone density, differences in use among various race/ethnic groups around the time of hip fracture may reveal disparities within the healthcare system., Methods: The 2014 to 2016 Medicare Standard Analytic Files PearlDiver data set was used to identify geriatric patients sustaining hip fracture. From that cohort, those who had a DEXA scan before or after their fracture were defined. For the defined cohorts, patient age, sex, Elixhauser Comorbidity Index, race/ethnicity, and income (based on zip code) were defined and compared with univariate and multivariate analyses., Results: Of 58,099 hip fracture patients, only 19.8% had had a DEXA scan before fracture and 3.9% of the remaining group had the DEXA scan after fracture. Of the hip fracture population, 91.0% identified as White and 9.0% as non-White (Native American, Black, Hispanic, Asian, or Other). Before hip fracture, controlling for other variables and compared with White patients, all non-White categories were at lesser odds of having had the DEXA scan. After hip fracture, Black, Hispanic, and other patients were also at lesser odds of having the DEXA scan., Discussion: Using a large Medicare data set, controlling for patient age, sex, Elixhauser Comorbidity Index, and income marker, this study revealed disparities in DEXA scan utilization across race/ethnic groups before and after presenting with a hip fragility fracture. Identification of such disparities highlights the needs for improved medical access and care for this at-risk hip fracture population., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: Geriatric hip fractures are common and associated with high morbidity and mortality. This study aimed to evaluate the incidence, timing, and risk factors of contralateral hip fracture after initial hip fracture., Methods: Initial hip fractures in patients older than 65 years were abstracted from the national, administrative M91Ortho PearlDiver data set. Incidence and timing of contralateral hip fractures in the following 10 years were identified. Kaplan-Meier survival analysis until contralateral hip fracture was conducted. To account for patient mortality over the later years, 2-year univariate and multivariate analyses were used to determine factors predictive of contralateral hip fracture., Results: Of the initial 104,311 hip fractures identified, contralateral hip fracture in the 10 years that followed was identified for 7,186 (6.9%), of which 68.4% occurred in the first 2 years. Kaplan-Meier survival analysis until contralateral fracture revealed the 10-year incidence to be 12.9% when controlling for those lost from the data set during the study period. Multivariate logistic regression revealed independent predictors of contralateral hip fracture in the 2 years after index hip fracture, when the incidence was greatest, to be female sex (odds ratio [OR] 1.15), body mass index < 20 (OR 1.30), and percutaneous pinning surgery for initial hip fracture fixation (OR 1.58) (P < 0.0001 for each)., Conclusions: In a national cohort of 104,311 geriatric hip fractures, Kaplan-Meier analysis for contralateral hip fracture found the 10-year incidence to be 12.9%, of which nearly 70% were in the first 2 years, and predisposing factors were defined. As such, future research should aim to identify the cause and mitigate the risk of secondary contralateral hip fractures in geriatric patients., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction: Hip fracture surgery is associated with notable morbidity. Understanding the timing of adverse events can inform strategies for prevention and management. Owing to database limitations, many studies have limited postoperative follow-up to 30 days. However, adverse events may not have plateaued by this time. This study evaluated adverse events after hip fracture surgery out to 90 days., Methods: Hip fracture surgeries in patients 65 years or older were identified in the 2010 to 2020 Q3 M91Ortho PearlDiver data set using administrative codes. The 90-day incidence and time of diagnosis of 10 common adverse events were determined and used to calculate median, interquartile range, and middle 80% for time of diagnosis. The number of events occurring before and after 30 days was also determined., Results: A total of 258,834 hip fracture surgery patients were identified. On average, 70% of adverse events occurred in postoperative days 0 to 30 and 30% occurred in days 31 to 90. The percentage of events in days 31 to 90 ranged from 8% (transfusion) to 42% (wound dehiscence). Compared with patients with a 0- to 30-day adverse event, those with 31- to 90-day adverse events had higher average Elixhauser Comorbidity Index scores (8.6 vs. 7.8, P < 0.001) and a slightly greater proportion of men (31.5% vs. 30.2%, P < 0.001).For specific adverse events, the time of diagnosis (median; interquartile range; middle 80%) were as follows: transfusion (2 days; 1 to 4 days; 1 to 24 days), acute kidney injury (5; 2 to 26; 1 to 55), cardiac event (9; 3 to 35; 1 to 64), urinary tract infection (13; 3 to 39; 1 to 65), hematoma (14; 6 to 28; 3 to 52), pneumonia (15; 5 to 39; 2 to 66), venous thromboembolism (16; 5 to 40; 2 to 64), surgical site infection (23; 14 to 37; 7 to 56), sepsis (24; 9 to 48; 3 to 71), and wound dehiscence (26; 15 to 41; 7 to 64)., Discussion: Nearly one-third of 90-day adverse events after hip fracture surgery were found to occur after postoperative day 30. An understanding of the timing of adverse events is important for improving patient counseling and optimizing patient care., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)