Unplanned emergency room visits within 30 and 90 days after osteoporotic hip fracture surgery: A comprehensive risk factor analysis

Abstract

Hip fractures in older adults are associated with high comorbidity and mortality rates. Despite efforts to reduce hospital stay, early emergency room (ER) visits and readmissions remain common and can negatively impact outcomes. In this study, we aimed to evaluate the incidence, causes, and risk factors of unplanned ER visits within 30 and 90 days following hip fracture surgery. A retrospective review was conducted of 4551 patients who underwent hip fracture surgery at a single institution between 2005 and 2024. Demographics, perioperative variables, and clinical risk factors were analyzed using univariate and multivariate logistic regression. ER visits within 30 and 90 days post-discharge were categorized as surgical or non-surgical and compared with control groups without ER visits. The rates of unplanned ER visits were 6.8 % within 30 days and 12.2 % within 90 days after discharge. Multivariate analysis identified low body mass index (BMI) and higher Charlson Comorbidity Index scores as significant risk factors for ER visits at both time points. Non-surgical complications—most commonly gastrointestinal and pulmonary—were the leading causes of ER visits. Among surgical complications, hip arthroplasty dislocation was the most frequent cause at both 30 and 90 days. Unplanned ER visits following hip fracture surgery are primarily driven by non-surgical complications. Low BMI and poor preoperative comorbidity status are key risk factors. Targeted preventive strategies, including those addressing modifiable surgical risks, such as prosthetic dislocation, may help reduce ER utilization and improve postoperative outcomes.