Factors associated with early follow-up attendance after geriatric hip fracture surgery

Abstract

PURPOSE: To identify sociodemographic and clinical factors associated with early postoperative follow-up after geriatric hip fracture surgery, and to determine whether absence of early follow-up was independently associated with one-year mortality. METHODS: Design: Retrospective cohort study. SETTING: Two urban Level 1 trauma centers in the United States. Patient Selection Criteria: Patients ≥ 70 years who underwent surgery for proximal femur fractures between 2018 and 2024. Exclusion criteria were pathologic or periprosthetic fractures, death or readmissions within six weeks post-discharge, and no planned follow-up at the study sites. Outcome Measures and Comparisons: The primary outcome was early follow-up attendance, defined as a surgeon visit within six weeks post-discharge. Secondary outcome was one-year mortality by follow-up status. Multivariable logistic regression identified factors independently associated with non-attendance and its independent association with one-year mortality. RESULTS: A total of 2118 patients were included of whom 632 (29.8%) did not attend an early follow-up appointment. Median age was 84 years (IQR: 78-90) and 68.6% were female. Male sex (aOR: 0.76, 95% CI: 0.62-0.94, p = 0.011), current smoking (aOR: 0.55, 95% CI: 0.38-0.82, p = 0.003), and distance from residence to hospital > 25 miles (aOR: 0.51, 95% CI: 0.39-0.65, p < 0.001) were independently associated with non-attendance. Non-attendance was independently associated with increased one-year mortality (aOR: 2.21, 95% CI: 1.75-2.80, p < 0.001). CONCLUSIONS: Males, current smokers, and those residing more than 25 miles from the hospital are less likely to attend their early follow-up appointment. Not attending early postoperative follow-up is independently associated with doubled one-year mortality risk in the geriatric hip fracture population. Targeted interventions to improve follow-up are needed as they could help reduce disparities arising from non-modifiable factors and support health equity.