European Journal of Orthopaedic Surgery & Traumatology · Nov 11, 2026
Association between Alzheimer’s disease and related dementias and postoperative outcomes after geriatric hip fracture surgery
By Vu NH, Esper GW, Pettit C et al.
Background Patients with Alzheimer’s Disease and Related Dementias (ADRD) represent a vulnerable subset of geriatric hip fracture patients, yet the extent to which ADRD influences postoperative outcomes remains incompletely characterized. The purpose of this study was to examine the association between Alzheimer’s Disease and Related Dementias (ADRD) and outcomes. Methods A retrospective cohort analysis was conducted of patients 65 years or older undergoing operative management for hip fractures at a multi-site urban academic medical center. Patients were stratified by ADRD status as documented in the electronic medical record. Univariate analyses compared demographic characteristics, injury and surgical variables, hospital quality metrics, and mortality using chi-square and Student’s t-tests, as appropriate. Multivariable regression models controlling for age, sex, BMI, ASA class, Charlson Comorbidity Index, baseline functional status, and fracture classification evaluated the association between ADRD and study outcomes. Results A total of 3,312 patients were included: 829 (25.0%) ADRD vs. 2483 (75.0%) control. ADRD patients were older, had greater comorbidity burden, and had worse baseline functional status. ADRD patients had increased minor and major complications, ICU admissions, readmissions, 1-year mortality, and longer hospitalization (all p < 0.001). Variance inflation factor analysis confirmed no meaningful multicollinearity among covariates (VIF range 1.04–1.34). On multivariable analysis, ADRD was independently associated with major complications (OR 1.372, 95% CI 1.066–1.760), ICU admission (OR 1.581, 95% CI 1.231–2.025), length of stay (β 0.958, 95% CI 0.624–1.292), 30-day (OR 1.994, 95% CI 1.521–2.608) and 31- to 90-day readmission (OR 1.956, 95% CI 1.453–2.625), and mortality between 31 days and 1 year (HR 1.54, 95% CI 1.18–2.01). Conclusion ADRD is independently associated with worse postoperative outcomes after geriatric hip fracture. These associations persisted after adjustment for baseline comorbidity, functional status, and fracture classification, though residual confounding by unmeasured frailty domains cannot be excluded. Orthogeriatric co-management should be directed toward this vulnerable population to optimize outcomes.