According to current estimates, more than 300,000 patients—mostly people aged 65 and older—sustain a hip fracture each year in the United States, and the annual incidence is expected to exceed 500,000 by 2040. Hip fractures often result in nursing home stays, higher mortality, and lower quality of life. The expected rising incidence will place a significant financial burden on patients, families, insurers, and other key stakeholders. Surgery is the primary treatment strategy for hip fractures because it can reduce mortality risk and improve physical function, but less is known about the societal cost implications of hip fractures.

New Data

Little is known about the return on investment of surgery for hip fracture patients, says Lane Koenig, PhD. “Policymakers and payers are increasingly focusing on value, making it critical to understand the return from healthcare spending,” he says. To investigate this further, Dr. Koenig and colleagues conducted a study—published in Clinical Orthopaedics and Related Research—that estimated the impact of surgical and nonsurgical treatment in patients aged 65 and older. The research team reviewed published literature and expert opinions to examine a comprehensive set of outcomes, including long-term medical costs, home modification costs, and costs associated with long-term nursing home care.


For the study, Dr. Koenig and colleagues developed a predictive tool to account for various possible outcomes so that they could measure the cost and potential savings of repairing hip fractures with surgery. “Our results showed that surgery provided a significant societal benefit and value by returning patients to active, independent living,” Dr. Koenig says. The average lifetime societal benefits in the U.S. reduced medical and nursing home costs of hip fracture surgery by $65,000 to $68,000 per patient. From a national perspective, hip fracture surgery yielded lifetime societal savings of about $16 billion.

Surgery for hip fracture increased direct medical costs by around $20,000 per patient, but these expenses were offset by lower long-term medical costs of $2,000 to $3,000 and lower nursing home costs of over $80,000. “The savings seen in our study were due to reductions in long-term medical care and the assistance that is needed,” says Dr. Koenig.

Quantifying Value

Surgery will not be appropriate for all patients with hip fractures, but the study quantifies the economic value of using surgery for hip fractures in terms of reducing lifetime medical and custodial care costs to society. Although the magnitude of these savings depends on model assumptions, the findings on societal savings were robust. “Our analysis can serve as an important benchmark for the economic value of surgery for these individuals,” Dr. Koenig says.”


Gu Q, Koenig L, Mather RC 3rd, Tongue J. Surgery for hip fracture yields societal benefits that exceed that direct medical costs. Clin Orthop Relat Res. 2014 Aug 5 [Epub ahead of print].Available at:

Haentjens P, Magaziner J, Colón-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152:380-390.

Tosteson A, Gottlieb D, Radley D, Fisher ES, Melton LJ 3rd. Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int. 2007;18:1463-1472.

Hossain M, Neelapala V, Andrew JG. Results of non-operative treatment following hip fracture compared to surgical intervention. Injury. 2009;40:418-421.

Giversen IM. Time trends of mortality after first hip fractures. Osteoporos Int. 2007;18:721-732.