Predictors for in-hospital outcomes in older patients with hip fracture and atrial fibrillation: A Nationwide Inpatient Sample analysis (Preprint)

BACKGROUND Older adults with pre-existing atrial fibrillation (AF) who sustain a hip fracture that requires surgery are at increased risk of morbidity and mortality. OBJECTIVE This study aims to identify predictors of in-hospital mortality and prolonged length of stay (LOS) in these patients. METHODS The United States (US) Nationwide Inpatient Sample (NIS) database was retrospectively reviewed for patients ≥ 60 years old with AF who underwent surgical management of a hip fracture between 2016 and 2020. Outcomes evaluated were in-hospital mortality and prolonged LOS (≥ 75th percentile). Multivariable logistic regressions were performed to identify risk factors for these outcomes. RESULTS Among 43,667 eligible patients, the strongest predictors for in-hospital mortality were sepsis (adjusted odds ratio [aOR] = 6.45), respiratory failure (aOR = 5.91), liver disorders (aOR = 2.61), and acute kidney injury (aOR = 2.40). Other predictors were pneumonia, advanced age, high Injury Severity Score (ISS ≥ 16), deep vein thrombosis, pulmonary embolism, and heart failure with reduced ejection fraction (HFrEF). For prolonged LOS, the strongest independent predictors included sepsis (aOR = 4.84), pneumonia (aOR = 3.25), deep vein thrombosis (aOR = 4.62), respiratory failure, and advanced age. CONCLUSIONS These results indicate the impact of critical complications and comorbidities on in-hospital mortality and LOS in elderly hip fracture patients with pre-existing AF. These findings particularly support the need for vigilance and enhanced perioperative management targeting sepsis, respiratory complications, and kidney function to improve outcomes in this high-risk group.