The Relationship Between Alcohol Misuse and Fracture Outcome in the Elderly

Abstract

Research Question: Do elderly patients (> 60 years old) admitted to the hospital with fractures and chronic alcohol misuse demonstrate differing healing outcomes, in comparison to those with fractures and no chronic alcohol misuse? Specifically, do these patients differ in 1) healing fractures, 2) length of hospital stay, 3) length of ICU stay, and/or 4) mortality?

Background and Significance: Alcohol is attributed to a variety of health issues and continues to prove to have adverse health effects. The causative relationship between alcohol and fracture is strong for both osteoporosis and fracture risk. However, there are few studies that have evaluated clinical outcomes of alcohol related injury or hospital-based outcome, such as length of stay. If different than non-alcohol related injuries, this alcohol-related injury pattern may allow healthcare workers better understanding for what to expect, how to intervene, and what outcomes may occur. Additionally, cessation intervention to address the treatment of osteoporosis and additional fractures may carry both personal and societal benefits.

Materials and Methods: A retrospective cohort study and chart review was performed. Patients admitted to Texas Health Harris Methodist Fort Worth with fractures of the axial skeleton and spine between January 2010 and December 2019 were identified for the study. Patients who presented with fractures and 1) laboratory test for ethanol level, and 2) those undergoing substance abuse screening using the SBIRT tool were then evaluated for outcomes including length of hospital stay, length of ICU stay, and mortality. The specific results of the Alc(+) group were then compared to the Alc(-) group.

Results: The results showed that there was no statistically significant difference in mean hospital length of stay (LOS), no statistically significant difference in mortality, and a statistically significant longer mean ICU LOS days Alc(+) compared to Alc(-). The mean ICU LOS was estimated to be 0.95 days longer (95% CI [0.20, 1.71 days]) for the Alc(+) group than the Alc(-) group.

Conclusion: Geriatric patients screening positive for alcohol misuse had a longer ICU stay, increased risk for nosocomial infections, and other complications. This would be expected to increase individual and hospital costs, and use of resources. Ultimately, identifying these ¿at risk¿ patients could lead to early mitigating interventions on hospital admission and another good reason for physicians to address alcohol misuse and bone health. This program could be a model for other centers to also improve individual outcomes as well as have an impact in overall healthcare spending and resources.