A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery

Abstract

BackgroundA fracture neck of femur is the leading cause of injury-related mortality in the elderly population. The 30-day mortality figure is a well utilised marker of clinical outcome following a fracture neck of femur. Current studies fail to analyse all patient demographic, biochemical and comorbid parameters associated with increased 30-day mortality. We aimed to assess medical risk factors for mortality, which are easily identifiable on admission for patients presenting with a fractured neck of femur.MethodsA retrospective review of a prospectively populated database was undertaken to identify all consecutive patients with a fracture neck of femur between October 2008 and March 2011. All factors related to the patient, injury and surgery were identified. The primary outcome of interest was 30-day mortality. Univariate and subsequent multivariate analyses using a backward stepwise likelihood ratio Cox regression model were performed in order to establish all parameters that significantly increased the risk of death.ResultsA total of 1,356 patients were included in the study. The 30-day mortality was 8.7%. The most common causes of death included pneumonia, sepsis and acute myocardial infarction. Multiple regression analysis revealed male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than 10 g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score and liver disease to be significant predictors of mortality.ConclusionsThis study has elucidated risk factors for mortality using clinical and biochemical information which are easily gathered at the point of hospitalization. These results allow for identification of vulnerable patients who may benefit from a prioritisation of resources.

The association between pre‐operative sepsis and 30‐day mortality in hip fracture patients—A cohort study

“…In a large retrospective study of 38 020 hip fracture patients, an overall 30‐day mortality of 10% was found . In a similar study of 1356 patients, the 30‐day mortality was 8.7% following hip fracture surgery . Our data on time from admission to surgery are close to the Danish national quality index target of having surgery within 24 hours of admission with a hip fracture.…”

“…Hip fracture occurs in approximately 100 of 100 000 people each year . Most hip fractures occur among the elderly and the perioperative mortality is substantial; 30‐day mortality is estimated to be between 5% and 13% . The underlying causes have been assessed in several studies and non‐modifiable factors such as age and pre‐existing comorbidities contribute to early death among hip fracture patients .…”

Do we really need a surgery for hip fractures in elderly patients? Mortality rate and influencing factors

“…Therefore, intertrochanteric fracture induces more bleeding and requires a longer operation time, more complicated surgical methods and requires avoiding full weight-bearing exercise after the operation. As a result, patients with intertrochanteric fracture showed a higher mortality rate than patients with femoral neck fracture [13][14][15]. However, there were also reports that there was no difference in mortality rates between the two fracture types [12,15].…”

Increasing Risk of Hospital-Treated Infections and Community-Based Antibiotic Use After Hip Fracture Surgery: A Nationwide Study 2005–2016

“…(5,8) About 9% to 11% of hip fracture patients have been reported to develop hospital-acquired pneumonia and 4% to 17.9% to develop urinary tract infection, (8)(9)(10)(11) within a varying follow-up time window spanning from during admission to 6 months of follow-up. Pneumonia is a leading cause of death among hip fracture patients, (12,13) and is associated with an excess mortality risk among hip fracture patients. (8,14,15) It has been suggested that the decrease in mortality among hip fracture patients over the last 20 years could be explained by improvement in both perioperative and postoperative patient care.…”