Healthcare utilization following hip fractures based on social vulnerability status in the US: an analysis of 2016-2020 nationwide readmissions data

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported but CIs exclude null

• Effect Size: OR 1.47 for long LOS, OR 1.23 for home discharge

• Primary Outcome: Length of stay ≥5 days and discharge disposition

• Nnt Or Sensitivity: Social vulnerability prevalence only 6.2% suggesting poor sensitivity of Z-code identification

• Confidence Interval: 1.41-1.54 for LOS, 1.16-1.30 for home discharge

Clinical Application

Limited by poor documentation of social vulnerability in routine clinical practice Limited applicability due to different healthcare system, insurance models, and social support structures. Australian focus on NDIS and aged care pathways differs from US Medicaid system Hip fracture patients in tertiary care settings with documented social risk factors

Abstract

INTRODUCTION: Social vulnerability (SV) influences rehabilitation and postoperative care for patients with hip fracture. However, most previous work relies on area-level measures that overlook interindividual variation. The recent adoption of ICD-10 Z-codes allows clinical identification of patient-level SV and may offer a better understanding of its impact. This study aimed to evaluate healthcare utilization, including readmissions, discharge disposition, and length of stay (LOS) in surgically treated hip fracture patients with and without clinically acknowledged SV. METHODS: Adults surgically treated for hip fracture between 2016 and 2020 were included from the Nationwide Readmissions Database. SV was defined as having at least one documented relevant ICD-10 Z-code. Primary outcome measures included complications, LOS, discharge disposition, and 30- and 90-day readmissions, stratified by SV and evaluated using chi-square analyses. Multivariable logistic regression assessed long LOS (≥ 5 days) and discharge to home, adjusting for age, insurance/income status, and substance use. RESULTS: Patients with SV were younger (35.6% with SV vs. 50.1% without SV were 81+), had a lower median household income (38.8% with SV vs. 25.7% without SV were in the lowest quartile), and were more often insured by Medicaid (19.3% vs. 3.8%). Alcohol/drug use disorders were significantly more prevalent in patients with SV (18.5% vs. 4.5%). SV was associated with 47% higher odds for long LOS (1.47, 1.41-1.54) and 23% higher odds for discharge to home (1.23, 1.16-1.30) but comparable 90-day readmissions (21.2% vs. 19.8%). CONCLUSION: Among surgically treated hip fracture patients, SV was associated with higher odds of long LOS and discharge to home but no meaningful difference in readmissions. The small number of patients with clinically documented SV highlights the limited reporting by healthcare workers. This analysis of a nationwide all-payer database highlights the need to identify these higher risk patients and implement appropriate care pathways to reduce healthcare utilization.

References

1. 1.Tilve, R., Zhou, G., Khan, S. T., Koroukian, S. M., Deren, M., & Piuzzi, N. S. (2026). Healthcare utilization following hip fractures based on social vulnerability status in the US: an analysis of 2016-2020 nationwide readmissions data. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1001/jamainternmed.2018.7998