NEW U.S. data analyzing 90-day outcomes after nonelective total hip arthroplasty (THA) for hip fracture reveals that male patients and those with pre-existing comorbidities face significantly higher risks of readmission and in-hospital mortality. The findings, derived from a nationally representative dataset, could help clinicians better stratify risk in older adults undergoing emergency hip surgery.
Researchers evaluated 346,030 nonelective primary THAs for hip fracture performed between 2016 and 2019 using the Nationwide Readmissions Database. Among these cases, 17.8% (n = 61,443) were readmitted within 90 days. Of the readmitted patients, the average age was 80.2 years, 62% were women, and 90.6% were Medicare beneficiaries.
After adjusting for age, socioeconomic factors, and hospital characteristics, multivariable logistic regression revealed that men had significantly higher odds of both readmission (adjusted odds ratio [aOR], 1.33) and in-hospital mortality during readmission (aOR, 1.32) compared with women. Conversely, female patients had lower risks: aOR of 0.75 (95% CI, 0.73–0.77) for readmission and 0.76 (95% CI, 0.69–0.84) for mortality (p < 0.001 for both). Medical comorbidity, as measured by the Deyo-Charlson Comorbidity Index, also showed a clear dose-response relationship with risk. Patients with index scores of 1 had an aOR of 1.53 for 90-day readmission, while those with scores ≥2 faced more than double the risk (aOR, 2.20; p < 0.001). Mortality during readmission was also significantly higher for these patients, with aORs of 1.20 and 1.69 respectively. The authors conclude that these findings underscore the importance of sex and comorbidity as independent risk factors for adverse outcomes following emergency hip arthroplasty. Targeted perioperative planning and closer post-discharge monitoring in these high-risk groups could improve survival and reduce readmissions. Further research is warranted to explore the mechanisms behind sex-based disparities and to develop intervention pathways aimed at mitigating these risks. Reference: Chandrupatla SR et al. Medical Comorbidity and Male Sex Are Associated With Higher In-hospital Mortality for 90-Day Readmissions and Higher Readmission Rates After Nonelective Primary Total Hip Arthroplasty for Hip Fracture. J Clin Rheumatol. 2025. doi: 10.1097/RHU.0000000000002236. [Epub ahead of print].
