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Mortality, inappropriate medication and length of hospital stay in older hip fracture patients: A general population-based cohort study

Annika Kragh Ekstam, Isam Atroshi, Solve Elmstahl

 Purpose: To assess if potentially inappropriate medication (PIM) or length of hospital stay (LOS)

are related to mortality in older hip fracture patients. Methods: A population-based cohort study in hip fracture patients’ ≥ 60 years, data from national registers. Mortality and LOS, were studied in patients exposed to PIM, compared to un-exposed patients. Beers’ criteria and a corresponding Swedish list were used to identify PIM. Logistic regression was used and data adjusted for age, sex and polypharmacy. Results: Of 2043 patients, 81.5% were exposed to PIM. Mortality was higher in males, age ≥ 80 years, and with polypharmacy (p<0.001, respectively). Exposure to any PIM was related to higher adjusted mortality, 30-day odds ratio (OR) 1.79 (95% CI 1.25-2.57) and 90-day 1.57 (95% CI 1.16-2.12). Exposure to PIM-analgesics (tramadole or dextropropoxyphene) was related to higher adjusted mortality; 30-day OR 2.59 (95%CI 1.85-3.63), 90-day 1.94 (95%CI 1.50-2.51), and 180-day 1.62 (95%CI 1.29-2.05). The increase was mainly due to tramadole and this effect was not seen with other strong analgesics. Adjusted LOS of ≥ 10 days, compared to 0-9 days, was associated with higher six-month mortality (p<0.001). Conclusion: Older hip fracture patients are frequently prescribed inappropriate medication, a potentially avoidable risk factor for adverse outcome. Inappropriate medication, especially analgesics, and an in-hospital stay of ten days or more can presumably be associated with higher mortality. To reduce adverse outcomes in older hip fracture patients, it is important to individually adapt medication, pain management and length of hospital stay.