Abstract
BACKGROUND: Hip fractures are a common source of disability in older adults. Depression, which is also prevalent in the elderly, has been correlated with negative surgical outcomes in other fields. The purpose of this study was to determine how hip fracture postoperative morbidity and mortality differ in older adults with depression compared with those without depression. METHODS: The National Inpatient Sample was queried from 2016 to 2021 for patients aged 65 years and older who were treated surgically for a hip fracture. Outcomes for patients with depression were compared with those without depression using univariate and multivariable regression models after accounting for demographic variables and comorbidities. The primary outcome was inpatient mortality. Secondary outcomes include deep vein thrombosis or pulmonary embolism (DVT/PE), myocardial infarction, infection, discharge disposition, length of stay, and total charges. RESULTS: A total of 307,377 patients were identified as having a hip fracture surgically repaired from 2016 to 2021 of whom 48,556 (15.8%) were depressed. Patients with depression were more likely to be female (76.3% and 68.6%, P < 0.01) and White (90.5% and 86.1%, P < 0.01). On multivariable regression analysis, patients with depression were more likely to experience inpatient mortality (odds ratio [OR]: 1.13 to 1.33, P < 0.01), DVT/PE (OR: 1.03 to 1.23, P = 0.01), and myocardial infarction (OR: 1.02 to 1.19, P = 0.02) than patients without depression. Patients with depression were also less likely to experience a routine discharge (OR: 0.62 to 0.66, P < 0.01) and were more likely to experience a longer length of stay (β coefficient 95% confidence interval, 0.46 to 0.54, P < 0.01) and greater total charges (β coefficient 95% confidence interval, 2,511 to 3,716, P < 0.01) than patients without depression. CONCLUSIONS: Patients with depression experienced increased odds of adverse events during their hospitalization including inpatient mortality, DVT/PE, and myocardial infarction. The lower odds of routine discharge and longer length of stay in depressed patients suggest that they may face a more difficult recovery process after surgery. Additional research is warranted to determine how long-term surgical outcomes are affected by depression and how interventions can influence these outcomes.