Outcomes following hip fracture surgery in adults with schizophrenia in Ontario, Canada: A 10-year population-based retrospective cohort study

Objective

To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia.

Methods

Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40–105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models.

Results

In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75–89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (_sdRH, 1.29; 95% CI, 1.09–1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12–1.54) and readmissions (OR, 1.40; 95% CI, 1.25–1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year.

Conclusions

Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.