Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia

Seigo Mitsutake; Reidar P. Lystad; Tolesa Okuba; Janet C. Long; Jeffrey Braithwaite; Takumi Hirata; Rebecca Mitchell

doi:10.1007/s00198-025-07536-8

Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia

Seigo Mitsutake, Reidar P. Lystad, Tolesa Okuba, Janet C. Long, Jeffrey Braithwaite, Takumi Hirata, Rebecca Mitchell

Australian Institute of Health Innovation

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Abstract

Summary: For older adults following a hip fracture who had hospital-acquired complications (HACs), hospital length of stay (LOS) and costs were over 40% higher compared to those without HACs. Improving strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system for an aged society.

Purpose: Although HACs can result in a high financial burden for health systems, little is known about the effect of common HACs on hospital LOS and cost among older adults after a hip fracture. This study examined the effect of HACs on hospital LOS and cost among older adults after a hip fracture.

Methods: This retrospective cohort study used linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2022. Older adults who were admitted after a hip fracture and discharged between July 2014 and June 2022 were identified. A 1:1 matched design was used to determine hospital LOS and care costs between older patients with and without HACs.

Results: Among 41,013 older patients hospitalised after a hip fracture, 14,050 (34.3%) experienced a HAC. The most common complication was healthcare-associated infections (43.1%). After matching, patients with HACs had a longer hospital LOS (median 31 days, IQR 17-47 days) compared to patients without HACs (median 22 days, IQR 9-35 days) (P < 0.001). Patients with HACs had higher hospital costs (median $84,779, IQR $44,296-$131,426) than patients without HACs (median $60,137, IQR $23,995-$100,300) (P < 0.001). For patients with HACs, hospital LOS was 43% longer (95% confidence interval (CI): 1.41-1.46), and hospital costs were 42% higher (95% CI: 0.40-0.44) compared to those without HACs.

Conclusions: Implementing strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system as HACs are potentially preventable.

Original language	English
Pages (from-to)	1267-1275
Number of pages	9
Journal	Osteoporosis International
Volume	36
Issue number	7
Early online date	16 Jun 2025
DOIs	https://doi.org/10.1007/s00198-025-07536-8
Publication status	Published - Jul 2025

Bibliographical note

Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Australia
Complication
Hip fracture
Hospital cost
Propensity score matching

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10.1007/s00198-025-07536-8Licence: CC BY-NC

Publisher version (open access)Final published version, 541 KBLicence: CC BY-NC

Cite this

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title = "Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia",

abstract = "Summary: For older adults following a hip fracture who had hospital-acquired complications (HACs), hospital length of stay (LOS) and costs were over 40% higher compared to those without HACs. Improving strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system for an aged society.Purpose: Although HACs can result in a high financial burden for health systems, little is known about the effect of common HACs on hospital LOS and cost among older adults after a hip fracture. This study examined the effect of HACs on hospital LOS and cost among older adults after a hip fracture.Methods: This retrospective cohort study used linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2022. Older adults who were admitted after a hip fracture and discharged between July 2014 and June 2022 were identified. A 1:1 matched design was used to determine hospital LOS and care costs between older patients with and without HACs.Results: Among 41,013 older patients hospitalised after a hip fracture, 14,050 (34.3%) experienced a HAC. The most common complication was healthcare-associated infections (43.1%). After matching, patients with HACs had a longer hospital LOS (median 31 days, IQR 17-47 days) compared to patients without HACs (median 22 days, IQR 9-35 days) (P < 0.001). Patients with HACs had higher hospital costs (median $84,779, IQR $44,296-$131,426) than patients without HACs (median $60,137, IQR $23,995-$100,300) (P < 0.001). For patients with HACs, hospital LOS was 43% longer (95% confidence interval (CI): 1.41-1.46), and hospital costs were 42% higher (95% CI: 0.40-0.44) compared to those without HACs.Conclusions: Implementing strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system as HACs are potentially preventable.",

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author = "Seigo Mitsutake and Lystad, {Reidar P.} and Tolesa Okuba and Long, {Janet C.} and Jeffrey Braithwaite and Takumi Hirata and Rebecca Mitchell",

note = "Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

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AU - Mitsutake, Seigo

AU - Lystad, Reidar P.

AU - Okuba, Tolesa

AU - Long, Janet C.

AU - Braithwaite, Jeffrey

AU - Hirata, Takumi

AU - Mitchell, Rebecca

N1 - Copyright the Author(s) 2025. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2025/7

Y1 - 2025/7

N2 - Summary: For older adults following a hip fracture who had hospital-acquired complications (HACs), hospital length of stay (LOS) and costs were over 40% higher compared to those without HACs. Improving strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system for an aged society.Purpose: Although HACs can result in a high financial burden for health systems, little is known about the effect of common HACs on hospital LOS and cost among older adults after a hip fracture. This study examined the effect of HACs on hospital LOS and cost among older adults after a hip fracture.Methods: This retrospective cohort study used linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2022. Older adults who were admitted after a hip fracture and discharged between July 2014 and June 2022 were identified. A 1:1 matched design was used to determine hospital LOS and care costs between older patients with and without HACs.Results: Among 41,013 older patients hospitalised after a hip fracture, 14,050 (34.3%) experienced a HAC. The most common complication was healthcare-associated infections (43.1%). After matching, patients with HACs had a longer hospital LOS (median 31 days, IQR 17-47 days) compared to patients without HACs (median 22 days, IQR 9-35 days) (P < 0.001). Patients with HACs had higher hospital costs (median $84,779, IQR $44,296-$131,426) than patients without HACs (median $60,137, IQR $23,995-$100,300) (P < 0.001). For patients with HACs, hospital LOS was 43% longer (95% confidence interval (CI): 1.41-1.46), and hospital costs were 42% higher (95% CI: 0.40-0.44) compared to those without HACs.Conclusions: Implementing strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system as HACs are potentially preventable.

AB - Summary: For older adults following a hip fracture who had hospital-acquired complications (HACs), hospital length of stay (LOS) and costs were over 40% higher compared to those without HACs. Improving strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system for an aged society.Purpose: Although HACs can result in a high financial burden for health systems, little is known about the effect of common HACs on hospital LOS and cost among older adults after a hip fracture. This study examined the effect of HACs on hospital LOS and cost among older adults after a hip fracture.Methods: This retrospective cohort study used linked hospitalisation and mortality data in New South Wales, Australia, between 2013 and 2022. Older adults who were admitted after a hip fracture and discharged between July 2014 and June 2022 were identified. A 1:1 matched design was used to determine hospital LOS and care costs between older patients with and without HACs.Results: Among 41,013 older patients hospitalised after a hip fracture, 14,050 (34.3%) experienced a HAC. The most common complication was healthcare-associated infections (43.1%). After matching, patients with HACs had a longer hospital LOS (median 31 days, IQR 17-47 days) compared to patients without HACs (median 22 days, IQR 9-35 days) (P < 0.001). Patients with HACs had higher hospital costs (median $84,779, IQR $44,296-$131,426) than patients without HACs (median $60,137, IQR $23,995-$100,300) (P < 0.001). For patients with HACs, hospital LOS was 43% longer (95% confidence interval (CI): 1.41-1.46), and hospital costs were 42% higher (95% CI: 0.40-0.44) compared to those without HACs.Conclusions: Implementing strategies for preventing HACs among older adults after a hip fracture would contribute towards a sustainable healthcare system as HACs are potentially preventable.

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KW - Complication

KW - Hip fracture

KW - Hospital cost

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JO - Osteoporosis International

JF - Osteoporosis International

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Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Harnessing implementation science, complexity science and evidence-based care to Keep Australians Out of Hospital: leveraging seven natural experiments in New South Wales

Cite this

Effect of hospital-acquired complications on hospital length of stay and cost for older adults after a hip fracture in New South Wales, Australia

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Projects

Harnessing implementation science, complexity science and evidence-based care to Keep Australians Out of Hospital: leveraging seven natural experiments in New South Wales

Cite this