Grant: Catalyst Gr: Addres. Musculoskeletal Cond./Arthritis in Cnds - Back/Neck pain

Low-energy osteoporotic pelvic and thoracolumbar fractures are quite common and are increasing given the aging population in North America. These fractures can happen with relatively benign trauma including fall from standing height, and although they can be managed without surgery, they are typically extremely painful for patients which limits mobility and significantly reduces quality of life. Management is aimed toward mobilizing patients as soon as possible and limiting the sequalae of immobility in an already fragile population. Patients are routinely admitted to acute care hospitals to facilitate pain management and disposition to a rehabilitation institute. However, while awaiting transfer, these patients typically receive minimal physical therapy which exacerbates the subsequent decline in function and increases the risk for future medical complications and health care needs. Unlike similar fractures, there is very limited evidence on the effect of hospitalization and rehabilitation on mortality, medical complications and future healthcare needs in this population. Evidence in those with hip fractures demonstrates that a length of stay in hospital of longer that 24 hours prior to fixation surgery results in increase mortality. This has been hypothesized to be due to the increase risk of immobility which include increased cardiovascular risk, worsening osteoporosis, increased metabolic side-effects and reduced long-term muscle mass and associated function. This study will analyze the association of admission and acute care length of stay on mortality and patient health using population-level data on ambulatory care visits and hospital admissions for fragility fractures of the pelvis and thoracolumbar spine. This data will allow for the identification of a specific threshold for length of stay after which patient outcomes suffer. This information will inform policy, potentially leading to the development of an alternate care pathway for these patients.