Outcomes Following Geriatric Hip Fracture Surgery in Diabetic Patients: A Nationwide Population-based Matched Cohort Study

Abstract

Hip fracture is a common disease for older people, and operative management provides more benefits than conservative treatment. However, the optimal surgical options for geriatric patients with hip fractures remain debated. To compare the clinical outcomes of hemiarthroplasty versus internal fixation in diabetic patients with a fragility hip fracture. This retrospective cohort study utilized data from the Taiwan National Health Research Insurance Database. Patients with type 2 diabetes who underwent hemiarthroplasty or internal fixation for a first-ever fragility hip fracture between 2000 and 2013 were enrolled. The primary outcome was the incidence of major surgical complications within 1 year after surgery. Secondary outcomes included in-hospital complications, length of stay, medical costs, readmission, and mortality. After propensity score-matching, there were 26,499 patients in each group (hemiarthroplasty vs. internal fixation). Hemiarthroplasty was associated with higher rates of in-hospital complications, including delirium, urinary tract infection, pneumonia, and surgical site infections, but showed a lower risk of transfusion. After index hospitalization, hemiarthroplasty patients had an increased risk of deep infections (subdistribution hazard ratio [SHR] = 1.35 and 95% confidence interval [CI]: 1.15–1.60), but lower risks of revision surgery (SHR = 0.43 and 95% CI: 0.38–0.49) and overall surgical complications (SHR = 0.74 and 95% CI 0.67–0.81). Internal fixation patients demonstrated higher readmission risk at 3 months and 1-year follow-up. However, the mortality risk was comparable between these two groups. While hemiarthroplasty was associated with higher in-hospital complications, it offered advantages over internal fixation in reducing reoperation and readmission rates postdischarge, making it a viable option for diabetic patients with hip fractures.