Trends in Outcomes and Hospitalisation of Head and Neck of Femur Fractures in Patients with Hemophilia - an Analysis of the National Inpatient Sample (NIS) (2016-2020)

Introduction

Hemophilias are one of the most common inheritable X-linked bleeding disorders that occur due to coagulation factor deficiencies, factor VIII deficiency in Hemophilia A, and factor IX deficiency in Hemophilia B, associated with severe bleeding following minor trauma or surgery. In childhood, hemophiliacs can experience arthropathies due to recurrent intra-articular bleeding, leading to an increased risk of immobilization in this population, predisposing them to osteoporosis and fragility fractures. There is limited data regarding the sociodemographic disparities in patients with hemophilia who are admitted with head and neck femur (HNF) fractures. This study identifies hospitalization trends and factors contributing to mortality in this population.

Methods

We conducted a retrospective study utilizing National Inpatient Sample data from 2016 to 2020. Using the International Classification of Diseases, 10th revision codes, we identified patients 18 years or older admitted with HNF fractures. The cohort was divided into those with a history of hemophilia and those without a history of hemophilia. Baseline characteristics were identified and compared between the two groups. Analysis was performed with STATA, and a 2-sided P< 0.05 was considered statistically significant.

Results

There were a total number of 822,324 hospitalizations for HNF fractures, and there were a total of 43,929 hospitalizations of patients with a history of hemophilia during this duration. There was a significantly higher proportion of men in patients with HNF fracture and hemophilia compared to those without (p= 0.05). The mean age of patients with HNF fractures and hemophilia was 47 years old, significantly lower than the mean age of those without hemophilia. The mean length of stay was longer in patients with HNF fractures and hemophilia than those without, 7 vs. 5.7 days. Patients with HNF fractures and hemophilia were also associated with higher total charges during hospitalization of $157866 vs $53527.99 (p=0.0000) in patients without hemophilia. Insurance status revealed that 84.94% of patients with HNF fractures without hemophilia had Medicare, while only 72.73% of such patients with hemophilia had Medicare (p=0.029). Interestingly, sociodemographic factors such as racial distribution (white, African-American, Hispanic, Asian or Pacific Islander, and Native American, p=0.82), median household income (p=0.11), and hospital geographical distribution (p=0.53) did not differ significantly between both groups.

Conclusion

Overall, a very small proportion of patients with HNF fractures had a concomitant history of hemophilia, attributed to the rarity of the disorder in the general population. Patients with HNF fractures and hemophilia were younger, likely due to recurrent arthropathies leading to earlier onset of osteopenia/osteoporosis. These patients also had longer lengths of stay and were associated with higher total charges during hospitalization, explained by the need to administer the costlier factor therapy in patients with hemophilia. Our findings, though limited to hospitalized patients, emphasize the need for further studies to evaluate fracture risk and earlier screening for osteoporosis in hemophilia patients in order to prevent and improve outcomes of fragility fractures and related comorbidities in this population.