Outcomes of isolated hip fractures in people with Parkinson's disease: An observational cohort study using propensity score methods

Background People with Parkinson's disease (PwP) have a high risk of hip fracture and the outcomes of PwP in Australia with hip fractures are unknown. Objective To describe the characteristics of PwP who present with a hip fracture and to examine the association between Parkinson's with acute hospital outcomes, mortality and discharge destination. Methods We conducted a cohort study of individuals with an isolated proximal femur fracture using the Victorian Orthopaedic Trauma Outcomes Registry (Australia) from 2016 to 2022. Demographic characteristics, comorbidities, fracture types, acute hospital length of stay, discharge destination and 30-day and 12-month mortality data were extracted. Inverse-probability weighting with estimated propensity scores determined the association of Parkinson's with outcomes, using a logistic regression model that included covariates and injury characteristics. Results Of 5,553 patients, 208 (4%) had PD, with a mean age of 79.9 years (SD 12.9). After propensity score adjustment, there was no association between Parkinson's and ICU admission (OR 1.89; 95% CI 0.67, 5.34), acute length of stay (adjusted median 6.9 vs 7.7) and 12-month mortality rates (OR 1.25; 95% CI 0.85, 1.82). PwP were more likely to be discharged to rehabilitation than home (RR 2.04; 95% CI 1.12, 3.74). Conclusions We did not observe a statistically significant difference in acute hospital outcomes between the two cohorts, including length of stay. This is encouraging as avoiding prolonged hospitalisation reduces health care costs and risk of hospital-related harms. However, these findings may reflect limited statistical power and differences between groups cannot be excluded. Further research is also indicated to explore post-care discharge pathways and longer-term functional outcomes of this group.