Archives of Orthopaedic and Trauma Surgery (2018) 138:331–337
Is treatment of geriatric hip fracture patients cost-covering? Results
of a prospective study conducted at a German University Hospital
· Juliana Hack
· Daphne Eschbach
· Steen Ruchholtz
· Matthias Knobe
· Richard Dodel
Received: 25 July 2017 / Published online: 2 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Introduction Hip fractures have increased medical and socio-economic importance due to demographic transition. Informa-
tion concerning direct treatment costs and their reimbursement in Germany is lacking.
Materials and methods Four hundred two hip fracture patients older than 60 years of age were observed prospectively at a
German University Hospital. Treatment costs were determined with up to 196 cost factors and compared to the reimburse-
ment. Finally, statistical analysis was performed to identify clinical parameters inﬂuencing the cost–reimbursement relation.
Results Treatment costs were 8853 € (95% CI 8297–9410 €), while reimbursement was 8196 € (95% CI 7707–8772 €),
resulting in a deﬁcit of 657 € (95% CI 143–1117 €). Bivariate analysis showed that the cost–reimbursement relation was
negatively inﬂuenced mainly by higher age, higher ASA score, readmission to the intensive care unit (ICU) and red blood
cell transfusion. Adjusted for other parameters, readmission to the ICU was a signiﬁcant negative predictor (− 2669 €; 95%
CI – 4070 to − 1268 €; p < 0.001), while age of 60–75 years was a positive predictor for the cost–reimbursement relation
(1373 €; 95% CI 265–2480 €; p = 0.015).
Conclusions Treatment of geriatric hip fracture patients in a university hospital in Germany does not seem to be cost-
covering. Adjustment of the reimbursement for treatment of complex hip fracture patients should be considered.
Keywords Ortho-geriatrics · Geriatric fracture · Hip fracture · Cost-eﬀectiveness · Treatment costs
In times of demographic transition, geriatric trauma surgery
is becoming more and more important. In 2011, 720,000
osteoporotic fractures were counted in Germany, of which
125,000 were hip fractures. These numbers are predicted to
rise by 28% by 2030 . The growing number of patients
will be challenging for the treating physicians. On the one
hand, the mostly poor bone quality is causing diﬃculties in
the operative fracture management. On the other hand, the
pre-existing conditions of geriatric patients are associated
with a higher rate of perioperative complications, higher
mortality, reduced health-related quality of life and diﬃcul-
ties in rehabilitation [2–4]. Therefore, geriatric fractures are
of great socio-economic importance.
According to a current investigation from the United
States, hospital costs of osteoporotic fractures in elderly
women are greater than those of myocardial infarction,
stroke or breast cancer .
Hip fractures are the most relevant osteoporotic fractures
in terms of costs . Previous studies have calculated costs
of around 10,000–15,000 € per case for the acute inpatient
treatment of hip fractures [7–9]. However, these numbers
are based upon account data and not real treatment costs.
Furthermore, reliable data concerning the situation in Ger-
many are lacking.
The aim of this prospective study, therefore, was to iden-
tify the detailed actual costs of the acute inpatient treatment
of hip fractures and to compare the costs with the reimburse-
ment (Question 1). Furthermore, clinical parameters which
* Rene Aigner
Center for Orthopaedics and Trauma Surgery, University
Hospital Giessen and Marburg GmbH, Baldingerstrasse,
35043 Marburg, Germany
Department of Neurology, University Hospital Giessen
and Marburg, Marburg, Germany
Department of Trauma and Reconstructive Surgery,
University Hospital RWTH Aachen, Aachen, Germany