Does a bicycle accident as the cause of proximal femur fracture indicate that geriatric co-management is superfluous? A retrospective cohort study

Petra E. Spies, Malene Fix, Benjamin L. Emmink, Tjard R. Schermer

Deployment of geriatric care would be more sustainable if we could limit geriatric co-management to older hip fracture patients who benefit most from it. We assumed that riding a bicycle is a proxy of good health and hypothesized that older patients with a hip fracture due to a bicycle accident have a more favorable prognosis than patients whose hip fracture was caused by another type of accident. Retrospective cohort study of hip fracture patients ≥ 70 years admitted to hospital. Nursing home residents were excluded. Primary outcome was length of hospital stay (LOS). Secondary outcomes were delirium, infection, blood transfusion, intensive care unit stay and death during hospitalization. The group with a bicycle accident (BA) was compared to the non-bicycle accident (NBA) group using linear and logistic regression  models, with correction for age and sex. Of the 875 patients included, 102 (11.7%) had a bicycle accident. BA patients were younger (79.8 versus 83.9 years, p < 0.001), less often female (54.9 versus 71.2%, p = 0.001) and lived independently more often (100 versus 85.1%, p < 0.001). Median LOS in the BA group was 0.91 times the median LOS in the NBA group (p = 0.125). For none of the secondary outcomes the odds ratio favored the BA group, except for infection during hospital stay (OR = 0.53, 95%CI 0.28-0.99; p = 0.048). Although older hip fracture patients who had a bicycle accident appeared more healthy than other older hip fracture patients, their clinical course was not more favorable. Based on this study, a bicycle accident is not an indicator that geriatric co-management can be omitted.